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Biomedical subjects

M Kristiansson

Publications and source records attributed to M Kristiansson.

At least 19 recordsLinked to original sources
PubMed2005

Postoperative delirium in elderly patients after major abdominal surgery.

BACKGROUND: The aim of this study was to investigate the occurrence of postoperative delirium (POD) in elderly patients undergoing major abdominal surgery and to identify factors associated with delirium in this population. METHODS: Data were collected prospectively from 51 patients aged 65 years or more. Delirium was diagnosed by the Confusion Assessment Method and from the medical records. The Mini Mental State Examination (MMSE) was used to identify cognitive impairment. RESULTS: POD occurred in 26 of 51 patients. Delirium lasted for 1-2 days in 14 patients (short POD group) and 3 days or more in 12 patients (long POD group). The latter patients had significantly greater intraoperative blood loss and intravenous fluid infusion, a higher rate of postoperative complications, a lower MMSE score on postoperative day 4 and a longer hospital stay than patients without POD. Patients in the short POD group were significantly older than those in the long POD group and those who did not develop delirium. CONCLUSION: Approximately half of the elderly patients in this study developed POD. Bleeding was found to be an important risk factor for delirium.

Abdomen↗
PubMed2005

Contrast-medium-Induced nephropathy correlated to the ratio between dose in gram iodine and estimated GFR in ml/min.

PURPOSE: To suggest a more precise tool when assessing the risk of contrast-medium-induced nephropathy (CIN), i.e. the ratio between contrast medium (CM) dose expressed in grams of iodine (g-I) and estimated glomerular filtration rate in ml/min (eGFR; based on equations using serum-creatinine (s-Cr), weight, height, age, and/or sex), here named I-dose/GFR ratio. MATERIAL AND METHODS: A Medline search of published CIN investigations reporting mean eGFR and mean dose of low-osmolality CM (LOCM) identified 10 randomized controlled prophylactic and 2 cohort coronary investigations, and 3 randomized and 1 cohort computed tomographic (CT) investigation. From the randomized trials, data were collected only from the placebo or control arms, unless there was no significant difference between the control and test groups. The mean I-dose/GFR ratio of each study was correlated with the mean frequency of CIN-1 (s-Cr rise> or =44.2 micromol/l or > or =20-25%) and CIN-2 (oliguria or requiring dialysis). A maximum dose according to an I-dose/GFR ratio= 1 in patients with s-Cr ranging from 100 to 300 micromol/l was compared with that of CIGARROA'S formula and with a "European consensus" threshold published by the European Society of Urogenital Radiology, both using s-Cr alone to predict renal function. McCullough's formula was used to assess the risk of CIN requiring dialysis at an I-dose/GFR ratio= 1 with LOCM. RESULTS: The coronary investigations revealed a linear correlation with a correlation coefficient between the I-dose/GFR ratio and the frequency of CIN-1 and CIN-2 of 0.91 (P<0.001) and 0.84 (P=0.001), respectively. At a mean I-dose/GFR ratio= 1, the regression line indicated a 10%) risk of CIN-1 and a 1% risk of CIN-2. At a mean I-dose/ GFR ratio=3, the risk of CIN-1 and CIN-2 increased to about 50% and 15%, respectively. Pooled weighted data from the CT investigations revealed a 12% risk of CIN-1 at a mean I-dose/GFR ratio = 1.1 and no cases of CIN-2. The maximum CM dose according to an I-dose/GFR ratio= 1 was about 30-50% of that of both Cigarroa's formula and the "European consensus" in elderly low-weight individuals, while it was similar for middle-aged individuals weighing about 90 kg. McCullough's formula suggests that there will be an exponentially increasing risk of CIN requiring dialysis, but at an I-dose/GFR ratio= 1 and using LOCM it will not exceed 1% until GFR decreases below 30 ml/min in diabetics and below 20 ml/min in non-diabetics. CONCLUSION: Using the I-dose/GFR ratio may be a more expedient way of improving risk assessment of CIN than today's common practice of estimating CM dose from volume alone and renal function from s-Cr alone. Prospective studies based on individual patient data are encouraged to define the risk of CIN at various I-dose/GFR ratios and correlated to type of CM, examination, risk factors, etc.

Adult↗
PubMed2005

Patient-circumference-adapted dose regulation in body computed tomography. A practical and flexible formula.

PURPOSE: To illustrate that the attenuation formula based on monochromatic radiation in homogeneous objects may be used for dose regulation in body computed tomography (CT) based on patient circumference and using a simple cloth measuring tape. MATERIAL AND METHODS: Based on the attenuation formula for monochromatic radiation the following Microsoft Excel equation was derived: mAs(x) = mAs(n)*EXP((0.693/ HVT)*(O(x)-O(n))/PI()), where mAs(x) (milliampere second) in a patient with circumference O(x) is calculated based on the nominal mAs(n) set for a reference patient with the circumference O(n) with regard to indication, scan protocol, and available CT scanner. The HVT = half-value thickness (object thickness change in cm affecting mAs setting by a factor of 2) resulting in the least mAs difference compared with published studies investigating the mAs needed for constant image noise in abdominal CT phantoms at 80-140 kVp was evaluated. Clinically recommended HVT values were applied to 20 patients undergoing abdominal CT using 130 effective mAs and 94 cm circumference as nominal settings, and an HVT of 9 cm. RESULTS: The object-sized dependent mAs for constant image noise at 80-140 kVp in 10-47 cm diameter abdominal phantoms (31-148 cm in circumference) differed, with few exceptions, by no more than 10% from those obtained with our formula using an HVT of 3.2-3.8 cm. An HVT of 9 cm in the patient study resulted in the same image noise-patient circumference relation as a phantom study using a "clinically adapted mAs" resulting in an acceptable noise according to diagnostic requirements. Clinical experiences recommend an HVT of about 8 cm for abdominal CT and 12 cm in thoracic CT. Changing the kVp from 120 to 80, 100, or 140 requires a mAs change roughly by factors of 4, 2, and 0.6, respectively, for constant image noise. CONCLUSION: Until fully automatic automatic exposure control systems have been introduced, applying the formula in a computer program provides the radiologist with an easy, quick, flexible, and practical instrument for reasonably good patient-sized adjusted exposure levels in clinical practice.

Adult↗
PubMed2002

Risk//need analysis in juvenile delinquents: an integrated multiprofessional longitudinal approach--a clinical pilot project.

OBJECTIVE: A clinical pilot project with the aim of performing a risk/need analysis in juvenile delinquents is presented. The main objective of this project was to test the feasibility of performing independent risk predictions by a forensic psychiatric team. METHOD: The organization, which involves a forensic psychiatric team, is described. Risk factors, risk prediction checklists and an analysis of crime characteristics and certain personality features with possible criminogenic implications are discussed. RESULTS: The feasibility of the project organization has been confirmed. CONCLUSION: It appears to be possible for an independent forensic psychiatric team to perform risk/need analysis in juvenile delinquents. The integration of clinical factors involving collaboration with staff at the juvenile detention home and checklists for risk prediction are recommended. Long-term follow up would make it possible to relate certain risk factors and evaluate risk management procedures to relapse in criminal behaviour and beneficial outcome, respectively.

Adolescent↗
PubMed2001

Juvenile and young adult mentally disordered offenders: the role of child neuropsychiatric disorders.

A retrospective study of the prevalence of child neuropsychiatric disorders was done involving pervasive developmental disorder (PDD), attention-deficit/hyperactivity disorder (ADHD), and Tourette syndrome in young offenders (15-22 years, n = 126) consecutively referred for presentencing forensic psychiatric investigation (FPI) in Stockholm, Sweden. Most offenders were referred for FPI because of serious offenses. Case report sheets were prepared, and retrospective neuropsychiatric DSM IV diagnoses were made by the first two authors. For best-estimated diagnoses, the case report sheets were then submitted to the fifth author, a child neuropsychiatrist with expertise in this area. Fifteen percent of the subjects had a definite diagnosis of ADHD, and another 15 percent had PDD, including 12 percent PDD not otherwise specified (NOS) and 3 percent Asperger syndrome. Autistic disorder was not found in any case. Tourette syndrome occurred in two percent of the cases. The rate of PDD is particularly striking. Neuropsychiatric diagnoses had been determined in the FPI in only a few cases. The contribution of constitutional problems to later criminal development may have been underestimated.

Adolescent↗
PubMed1999

Diminished interleukin-6 and C-reactive protein responses to laparoscopic versus open cholecystectomy.

BACKGROUND: Cytokines and their inhibitors are thought to be involved in many of the pathophysiological changes associated with trauma and infection. The magnitude of the trauma and the degree of tissue damage have an impact on the trauma response. The purpose of the study was to examine cytokine and hormonal responses to elective cholecystectomy and the extent to which these responses are influenced by the surgical procedure employed. METHODS: Sixteen patients, ASA grades I and II, were studied: 8 of them underwent laparoscopic cholecystectomy while the remaining 8 were operated on using the open technique. Systemic concentrations of tumour necrosis factor alpha (TNF), interleukin-1 beta (IL-1), interleukin-6 (IL-6), cortisol, epinephrine and norepinephrine were measured before and during the operation and subsequently for up to 48 h postoperatively. The degree of pain and fatigue were recorded during the study period. RESULTS: The preoperative levels of cytokines and hormones were all similar in the groups. Concentrations of TNF and IL-1 were detected only sporadically. The rise in plasma IL-6 was less marked following laparoscopic than after open cholecystectomy. However, the hormonal response was quite similar in the two groups. Pain and fatigue scores were lower (P < 0.05-0.01) in the laparoscopic group than in the open surgery group. CONCLUSION: In summary, cholecystectomy, irrespective of whether it was performed using the laparoscopic or open technique, was followed by a trauma response and increased pain and fatigue. However, the magnitude of stress, pain and fatigue was less pronounced in laparoscopic cholecystectomy patients. Concentrations of IL-6 seem to be more sensitive when it comes to delineating the trauma response than systemic norepinephrine and epinephrine levels.

Adult↗
PubMed1998

[A study of young offenders undergoing forensic psychiatric evaluation. There is a need of correctional care alternatives].

With effect from January 1, 1992, legislation regulating the practice of forensic psychiatry in Sweden, the Forensic Mental Care Act, was changed to meet more restrictive demands. A retrospective study of 15-20-year-old male offenders, investigated at the Dept. of Forensic Psychiatry in Stockholm during the period 1990-93, showed the proportion sentenced to forensic psychiatric care to have decreased by 21 per cent since the introduction of the new legislation. The majority of young offenders otherwise sentenced, mainly to correctional treatment, were suffering from personality disorders. Most of them had previously been in contact with the correctional and social service sectors. Several of them received prison sentences despite the fact that young offenders are not to be sent to prison without exceptional reasons. One such exceptional reason might be the lack of an appropriate alternative. A third treatment alternative is called for.

Adolescent↗
PubMed1998

Local vs. systemic immune and haemostatic response to hip arthroplasty.

Local and systemic immune and haemostatic responses were studied in 10 patients, aged 57-78 years, undergoing elective hip arthroplasty. Cytokines, soluble cytokine receptors, interleukin-1 receptor antagonist, soluble adhesion molecules, antithrombin, fibrin, soluble and fibrin D-dimer were analysed in wound drainage blood and in blood taken from the systemic circulation for up to 24 h post-operatively. Wound drainage blood concentrations of cytokines, interleukin-1 receptor antagonist and soluble cytokine receptors were increased compared with those in the systemic circulation except for the soluble interleukin-6 receptor. In wound drainage blood, soluble tumour necrosis factor receptors (P < 0.05), interleukin-1 receptor antagonist (P < 0.05) and interleukin-6 (P < 0.05-< 0.01) increased during the study period. In blood from the systemic circulation interleukin-6 increased (P < 0.05) while the soluble interleukin-6 receptor decreased (P < 0.05) compared with pre-operative values. Concentrations of soluble adhesion molecules did not change. Wound drainage blood showed marked hypercoagulation. After hip arthroplasty pro-inflammatory cytokines and their inhibitors were mainly confined to the local trauma site. A predominance for inhibitors was noted.

Aged↗
PubMed1997

[Screening of persons referred to forensic psychiatry. Many of them were in contact with psychiatric services before the offence].

Analysis of data for a sample comprising every second subject (266/533) who underwent forensic psychiatric examination in Sweden during a 12-month period (July 1995-June 1996) showed 50 per cent to have been in contact with psychiatric services during the 6-month period prior to the index offence. The study population was characterised by significantly higher than average proportions of women and of subjects suffering from psychotic disorder and/or serious psychiatric disorder as defined by the mental health act. In the subgroup who did not meet the criteria for special recommendations on medico-legal grounds (i.e., those without a serious psychiatric disorder according to forensic psychiatric examination) and in the youngest age group (< 20 years), the frequency of psychiatric contact prior to the index offence was lower than in the remainder, though the psychiatric consultation rate was nevertheless higher in both subgroups than in the general population. The findings suggest the need of increased alertness within the psychiatric sector, and of improved case management in the patient categories concerned. Further studies, particularly focused on violent and potentially violent offenders and their psychiatric contacts, are essential for the development of adequate programmes and guidelines for the treatment and care of such individuals.

Adolescent↗
PubMed1997

Generation of cytokines in red cell concentrates during storage is prevented by prestorage white cell reduction.

BACKGROUND: The effect of prestorage white cell (WBC) filtration on the cytokine content in red cells (RBCs) has not been clarified. STUDY DESIGN AND METHODS: Six units of buffy coat-poor RBC concentrates were prepared. Each unit was divided into three parts: one was used as a control, the second was made WBC-rich by the addition of WBCs from the buffy coat, and the third was made WBC-poor by filtration. All units were stored at 4 degrees C for 6 weeks. Immediately after preparation and every second week subsequently, samples for analyses of interleukin (IL) 1 beta (IL-1), IL-2, IL-6, IL-8, and tumor necrosis factor alpha (TNF alpha) were obtained. After 13 weeks, the procedure was repeated on the same donors. RESULTS: IL-2 was not detected. The amounts of IL-1, IL-8, and TNF alpha increased during the storage period. With the exception of IL-8, only low concentrations were found. Filtered units had lower concentrations of IL-1, IL-6, IL-8, and TNF alpha after 2 weeks of storage than did the control and WBC-rich units. The amounts of cytokines in filtered units did not increase during the study period. CONCLUSION: Prestorage filtration seems to diminish the amount of IL-1, IL-6, IL-8, and TNF alpha RBCs during storage. The possible clinical implications of this should be elucidated.

Adult↗
PubMed1997

Preoperative infiltration of bupivacaine--effects on pain relief and trauma response (cortisol and interleukin-6).

HYPOTHESIS: Subcutaneous infiltration of bupivacaine before skin incision can reduce postoperative pain and modulate the stress response. METHODS: In a randomized study on pain relief after hysterectomy 29 patients were referred into one of three groups, receiving 30 ml of bupivacaine 0.25% with adrenaline, 30 ml of saline or no infiltration along the line of the proposed incision 10 min before start of surgery. A Visual Analogue Scale was used for repeated pain ratings. Postoperative pain relief was provided with patient-controlled analgesia with intravenous morphine 0.04 mg/kg. Lockout time was 10 min. The immunological and endocrine stress response to trauma was reflected by blood interleukin-6 (IL-6) and cortisol concentrations measured during 72 h following skin incision. RESULTS: There were large individual variations in the accumulated postoperative consumption of morphine at 20 h after start of surgery. It was significantly reduced in patients receiving infiltration of bupivacaine. They used 39 mg (9-62) median (range) of intravenous morphine whereas the patients in the saline group used 65 mg (47-120) and patients in the control group used 54 mg (36-130) (P < 0.05). Significant elevation of plasma IL-6 and serum cortisol levels appeared in all groups with peak values at 3 h. There were no differences between the groups. There was a correlation between cortisol and IL-6. Six of the 29 patients had a postoperative infection which was reflected in increased IL-6 levels. CONCLUSION: Preoperative subcutaneous infiltration of bupivacaine significantly reduced the postoperative consumption of intravenous morphine.

Adult↗
PubMed1996

Prestorage versus bedside white blood cell filtration of red blood cell concentrates: effects on the content of cytokines and soluble tumor necrosis factor receptors.

BACKGROUND: The cytokine network has important implications for the systemic inflammatory and metabolic response in trauma and infection. The objective of this study was to investigate the influence of white blood cell (WBC) filtration on the cytokine content in red blood cell concentrates (RBCs). STUDY DESIGN AND METHODS: Tumor necrosis factor-alpha (TNF), interleukin-1-beta (IL-1), interleukin-6 (IL-6), interleukin-8 (IL-8), interleukin-10 (IL-10), and soluble TNF receptors I and II (sTNF-RI, sTNF-RII) were investigated in filtered and nonfiltered RBCs during storage. After 40 days of storage the originally nonfiltered units were filtered. RESULTS: On day 1 prestorage filtered RBCs had lower concentrations of WBCs (p < 0.001), TNF (p < 0.01), sTNF-RI (p < 0.01) and sTNF-RII (p < 0.05) compared to nonfiltered units. IL-1 concentrations increased from day 1 to day 40 (p < 0.05) in nonfiltered RBCs and were higher in nonfiltered units compared to prestorage filtered ones on day 40 (p < 0.05). An increase of IL-8 was found in nonfiltered RBCs as well as prestorage filtered units from day 1 to day 40 (p < 0.05) but the concentrations of IL-8 were higher in nonfiltered units on day 40 compared to prestorage filtered units (p < 0.05). Filtration at the end of the 40-day storage period had no influence on the concentrations of cytokines and soluble TNF receptors. CONCLUSION: The present results suggest that prestorage WBC filtration may be more efficient in reducing the cytokine content of RBCs compared to filtration at the the end of the storage period. The clinical impact of passive transfer of components of the cytokine network via RBCs, e.g., in critically ill patients, is however unclear and needs further investigations.

Adult↗
PubMed1996

Cytokines in stored red blood cell concentrates: promoters of systemic inflammation and simulators of acute transfusion reactions?

BACKGROUND: The cytokine network has important implications for the systemic inflammatory and metabolic response in trauma and infection. Cytokines exogenously administered to traumatized and infected patients may have implications for the trauma response in these patients. The main objective of this study was to characterize red blood cell concentrates (RBCs) with regard to cytokine content. METHODS: We investigated the concentrations of tumor necrosis factor alpha (TNF), interleukin-1 beta (IL-1), interleukin-6 (IL-6) and interleukin-8 (IL-8) in sixteen units of RBCs stored at +4 degrees C during 40 days. Samples from RBCs were taken every tenth day. Healthy volunteers were used as controls. RESULTS: IL-1 and IL-8 in RBCs were increased compared to controls, P < 0.01 - P < 0.001 and TNF in RBCs were increased on days 1 and 40 compared to controls, P < 0.05. During storage TNF was highest on day 1, 69 (< 3-1060) pg/ml, median (range). IL-1 concentrations increased during the period of storage from 5 (< 2 - 205) pg/ml to 174 (< 2 - 2180) pg/ml, P < 0.01. IL-6 was 6 (< 2 - 210) pg/ml on day 1 and did not change over the period of storage. IL-8 was highest on day 40, 164 (15 - 790) pg/ml and compared to day 1 the concentrations were increased on day 10 and day 40, P < 0.05 for both comparisons. CONCLUSIONS: The results indicate the presence of TNF, IL-1, IL-6 and IL-8 in stored RBCs, though there was a great variability over the period of storage and between units of RBCs. In some samples of RBCs the content of cytokines reached levels that may be anticipated to contribute to systemic inflammation and the symptomatology of acute transfusion reactions.

Adult↗
PubMed1995

Cytokine and coagulation characteristics of retrieved blood after arthroplasty.

OBJECTIVES: To investigate cytokine and coagulation/fibrinolysis characteristics in blood retrieved from wounds using an autotransfusion system, and to compare the cytokine pattern in the retrieved blood with those in the systemic circulation and in the initial portion of drainage blood from the wound. DESIGN: Prospective controlled clinical study. SETTING: The postoperative ward of a University hospital. PATIENTS AND PARTICIPANTS: Blood retrieval was performed over a period of 4-6 h on patients who had just undergone arthroplasty (nine hips, one knee). In five other cases involving hip arthroplasties, the initial portion of drainage blood was studied. MEASUREMENTS AND RESULTS: Coagulation/fibrinolysis parameters were analyzed in blood retrieved using the Stryker Consta Vac system. Concentrations of tumor necrosis factor alpha (TNF), interleukin-1 beta (IL-1) and interleukin-6 (IL-6) were analyzed in the retrieved blood, in the systemic circulation of the patients at the beginning and at the end of blood retrieval and in the initial portion of drainage blood from the surgical area. In the retrieved blood, the activities of thrombin, kallikrein and plasmin were increased, antithrombin and free protein S were decreased, and in all samples IL-6 was >1000 pg/ml. Postoperative plasma concentrations of IL-6 rose from a median value of 0 to 116 pg/ml (p <0.01). Four patients had circulating TNF concentrations (range: <15-50 pg/ml). Plasma IL-1 was not detected. TNF and IL-1 were detected in all samples of initial blood from the surgical area and IL-6 in one sample. CONCLUSION: Hypercoagulability and high concentrations of IL-6 were present in the retrieved blood. The cytokine pattern in the initial portion of blood from the surgical area differed from those in the retrieved blood and in the systemic circulation.

Aged↗
PubMed1995

Incurable psychopaths?

Treatment, comprising pharmacotherapy and an educational program based on cognitive behavior therapy, of four psychopathic, criminal men fulfilling the criteria for borderline personality disorder and antisocial personality disorder is described. The diagnoses were made during a forensic psychiatric evaluation. An estimation of the capacity of the central serotonergic system was performed by analysing the platelet monoamine oxidase (MAO) activity. The pharmacotherapy was combined with an educational program involving strategies for developing better impulse control. All four men had earlier been regarded as resistant to conventional therapy. In the present cases, a combined psychosocial and biological approach seemed to be effective in developing an increased control of impulses, leading to improved coping strategies. Controlled studies are needed in order to clarify whether the described treatment program proves beneficial.

Adult↗