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Biomedical subjects

M Malm

Publications and source records attributed to M Malm.

At least 19 recordsLinked to original sources
PubMed2006

Determination of eflornithine enantiomers in plasma, by solid-phase extraction and liquid chromatography with evaporative light-scattering detection.

A bioanalytical method for determination of eflornithine (DFMO) in 1000 microL human plasma has been developed and validated. DFMO and the internal standard (IS) were analysed by liquid chromatography with evaporative light-scattering detection (ELSD). Separation was performed on a Chirobiotic TAG (250 mm x 4.6 mm) column with ethanol (99.5%):0.01 mol/L acetic acid-triethylamine buffer at the rate of 25:75% (v/v) with flow rate of 1.0 mL/min. For d-DFMO in plasma the inter-assay precision was 6.5% at 75 micromol/L, 6.6% at 375 micromol/L and 5.8% at 750 micromol/L. For l-DFMO in plasma the inter-assay precision was 10.4% at 75 micromol/L, 6.5% at 375 micromol/L and 5.0% at 750 micromol/L. The lower limit of quantification (LLOQ) was determined to 25 micromol/L where the precision was 4.3% and 5.7%, respectively.

Chromatography, Liquid↗
PubMed2004

Automated solid-phase extraction method for the determination of piperaquine in capillary blood applied onto sampling paper by liquid chromatography.

A bioanalytical method for the determination of piperaquine in 100 microL blood applied onto sampling paper, by solid-phase extraction and liquid chromatography, has been developed and validated. Blood spots were cut into small pieces prior to addition of 0.3M perchloric acid, acetonitrile and phosphate buffer containing an internal standard. The liquid phase was loaded onto a mixed phase cation-exchange (MPC) solid-phase extraction column. Piperaquine and the internal standard were analysed by liquid chromatography and separated on a Chromolith Performance (100 mm x 4.6 mm) column with acetonitrile:phosphate buffer pH 2.5, I = 0.1 (8:92, v/v) at the flow of 3.5 mL/min. The UV detection was performed at 345 nm. The intra-assay precision was 12.0% at 0.150 microM, 7.3% at 1.25 microM and 7.3% at 2.25 microM. The inter-assay precision was 1.8% at 0.150 microM, 5.2% at 1.25 microM and 2.8% at 2.25 microM. The lower limit of quantification (LLOQ) was determined to 0.050 microM where the precision was 14.7%.

Antimalarials↗
PubMed2000

The lateral thoracodorsal flap in breast reconstruction: a comparison between two plastic surgical centres.

In a retrospective study the results of breast reconstruction with 146 lateral thoracodorsal flaps operated on during the period 1991-94 at the Departments of Plastic Surgery at the Sahlgrenska University Hospital in Göteborg and the Stockholm Söder Hospital were evaluated. The median age of the 135 patients was 51 years (range 37-74). About two thirds of the patients were also operated on on the opposite side at the same time; and this was done more often in Stockholm, which partly explains the longer operating time in Stockholm. Perioperative bleeding (median 100 ml, range 25-400) was similar in both groups. Median postoperative bleeding, which was measured only in Stockholm, was 300 ml (range 30-1000). Seromas were seen only in Göteborg where postoperative drains were rarely used. The rate of early complications (infection and partial necrosis) were higher in Stockholm where more flaps were raised in irradiated tissue. We conclude that the results were similar in the two centres, and the thoracodorsal flap gives good results. The incidence of early morbidity could be reduced by excluding patients who had been irradiated, by inserting drains, and by giving antibiotic prophylaxis.

Adult↗
PubMed2000

Clinical follow up of the lateral thoracodorsal flap in breast reconstruction: comparative evaluation from two plastic surgical centres.

A follow up study that compared the results from two plastic surgical centres comprised 95 patients after breast reconstruction with the lateral thoracodorsal (LTD) flap combined with either a smooth or textured saline-filled implant. It was conducted a median of 39 months (range 15-67) after the reconstruction. We investigated the size of the reconstructed breast and LTD flap, symmetry of the breasts, orientation of the mastectomy scar, and the rate of capsular contracture, which were similar in the two centres. However, according to the modified Baker classification and applanation tonometry reconstructions with smooth-surfaced implants and drainage of the implant pocket resulted in softer breasts (p = 0.03). The LTD flap technique in breast reconstruction was a good choice, particularly for women who required a minor breast reconstruction, and the technique can be recommended for suitable patients.

Back↗
PubMed2000

A prospective and randomized study, "SVEA," comparing effects of three methods for delayed breast reconstruction on quality of life, patient-defined problem areas of life, and cosmetic result.

During the last 30 years, many methods for delayed breast reconstruction have been described. There is a lack of prospective randomized trials comparing reconstruction methods. The present study (SVEA), conducted 1995 to 1996, describes the impacts of three methods: the lateral thoracodorsal flap, the latissimus dorsi flap, and the pedicled transverse rectus abdominis muscle flap (TRAM), on important areas of life, patients' perception of cosmetic result, and quality of life. Questionnaires were completed before randomization and at 6 and 12 months postoperatively. The preoperative questionnaire concerned the impact of breast loss and expectations on reconstruction. Follow-up questionnaires dealt with satisfaction with cosmetic result and impact on important areas of life. A health-related quality-of-life questionnaire (SF-36) was completed at all points of assessment. A total of 75 of 87 randomized patients underwent breast reconstruction: 16 patients with the lateral thoracodorsal flap, 30 with the latissimus dorsi flap, and 29 with the TRAM flap. The majority were very satisfied with the cosmetic result. Most women reported improvements in important areas of life, and quality of life in terms of "social functioning" and "mental health" increased significantly after the reconstruction. The latissimus dorsi flap and TRAM flap scored significantly higher as compared with the lateral thoracodorsal flap for similarity with the contralateral breast and reduced problems in social situations. No differences between irradiated and nonirradiated patients were found. All methods were considered to produce good cosmetic results and improvements in patient-defined problem areas of life and quality of life. No negative effects were recorded. Thus, irrespective of method, breast reconstruction is a valuable tool for the mastectomized woman to cope with problems in everyday life.

Activities of Daily Living↗
PubMed1999

A prospective randomised study (named SVEA) of three methods of delayed breast reconstruction. Study design, patients' preoperative problems and expectations.

A randomised study named SVEA to compare three methods for delayed breast reconstruction was initiated in 1994. The methods were: the lateral thoracodorsal flap, the latissimus dorsi flap, and the pedicled transverse rectus abdominis muscle flap. In the present paper we describe the study design, primary endpoints, and inclusion and exclusion criteria. Results from preoperative questionnaires about problems after mastectomy and expectations of the reconstruction are presented. The preoperative questionnaires, completed before randomisation, included a health related quality of life questionnaire, the SF-36, and a questionnaire concerning the impact of breast loss and expectations of the reconstruction. A total of 87 patients have been randomised in SVEA and 30 patients have been followed up outside the randomised study, comprising a reference group. The results from preoperative questionnaires, completed by 106 of the total 117 women, showed that they encountered many problems after mastectomy, primarily about feeling mutilated and being bothered socially. They held high expectations on the breast reconstruction in these areas. The women in the present study did not differ from Swedish women in general regarding health related quality of life, with two exceptions: the study sample scored lower on physical functioning and mental health.

Attitude to Health↗
PubMed1999

Clinical experience with the lateral thoracodorsal flap in breast reconstruction.

The lateral thoracodorsal flap is a local fasciocutaneous flap used for breast reconstruction. From 1986 to 1994 the authors used this flap in 157 breast reconstructions in 152 patients. The patients who had been treated with postmastectomy radiotherapy (N = 40) had significantly more (p < 0.01) early complications, such as necrosis and infection. Irradiated patients also required more operations due to secondary complications, such as capsular contracture (p < 0.05). A patient questionnaire (response rate, 91%) was sent to 121 patients and showed that, although a majority of patients felt the reconstructed breast was less sensitive to touch and harder than the contralateral breast, they still regarded the reconstructed breast as a natural part of themselves. More than 90% of patients did not regret the reconstruction and 80% would recommend it to a friend.

Adult↗
PubMed1998

Metabolism in myocutaneous flaps studied by in situ microdialysis.

The aim of this investigation was to follow the metabolism of myocutaneous flaps using microdialysis. After subcutaneous implantation of a microdialysis catheter into the flap tissue, serial samples were collected and changes in composition of the extracellular fluid assessed. Ten women underwent reconstructions with transverse rectus abdominis myocutaneous (TRAM) or latissimus dorsi flaps. Glucose, glycerol, and lactate concentrations were measured in the flaps and compared with those in adipose control tissue located over the hip. A transient rise in glucose was observed initially in the flaps. The glycerol concentration also increased significantly, and remained increased for approximately 12 hours after the operation. The lactate concentration changed in the same direction, but stayed elevated in the flap tissue during the entire investigation (24 hours). Neither of these parameters changed to the same extent in the control tissue. In one of the patients a haematoma developed postoperatively in the flap. This incident was accompanied by a sharp decline in glucose, and marked additional increases in glycerol and lactate concentrations. It may well be that this "metabolic pattern" in flap tissue signals threatening flap ischaemia. If so, this new microdialysis technique may be useful as a postoperative surveillance tool in myocutaneous flap surgery.

Adult↗
PubMed1998

The inflammatory reaction in elective flap surgery.

The inflammatory response in three different flap procedures was investigated by measuring the preoperative and postoperative levels of C-reactive protein, leukocyte count, and body temperature. Patients scheduled for delayed breast reconstruction were operated on with the lateral thoracodorsal flap, the latissimus dorsi flap, or the pedicled TRAM flap. All patients received 2 gm of intravenous cloxacillin for antibiotic prophylaxis and 1 gm of paracetamol four times a day as basic treatment for postoperative pain. Within each treatment group, significant postoperative changes in C-reactive protein levels, leukocyte count, and body temperature were noted when compared with preoperative values. The highest C-reactive protein level (130 mg/ml) was found in the TRAM group on the third postoperative day. The kinetic pattern of C-reactive protein was similar for the latissimus dorsi flap and lateral thoracodorsal flap procedures, but the maximum C-reactive protein levels were significantly lower, 74 and 44 mg/ml respectively. Small (0.5 to 0.9 degrees C) but significant differences in body temperature were also noted on the second and third postoperative day. The TRAM flap group had the highest, the latissimus dorsi flap group intermediate, and the lateral thoracodorsal flap group the lowest value. The postoperative C-reactive protein levels seem to reflect the extent of the surgical trauma.

Acute-Phase Reaction↗
PubMed1997

Serum creatine kinase in fasciocutaneous and musculocutaneous flap surgery.

The pre- and postoperative serum levels of creatine kinase (CK) were analyzed in 56 patients operated with three different breast reconstructive procedures. Thirteen patients were operated with the lateral thoracodorsal flap (LTD), 23 by the latissimus dorsi flap (LD), and 20 by the pedicled transverse rectus abdominis musculocutaneous (TRAM) flap. Nineteen patients in the LD and TRAM groups had received postmastectomy radiotherapy. The operations caused a significant rise in the serum levels of CK, and the highest levels were found on the first postoperative day: LTD, 5.4 microkat per liter; LD, 8.1 microkat per liter; and TRAM, 7.3 microkat per liter. There was no significant difference in CK levels between the groups. The irradiated patients did not show increased CK levels when compared with nonirradiated patients.

Adult↗
PubMed1997

Hamartoma of the breast: surgical treatment and reconstruction. Case report.

Hamartoma of the breast is a rare and usually benign tumour with a variable growth pattern. Slowly increasing breast asymmetry is the most common clinical finding. Smaller hamartomas are often diagnosed on mammography. Simple enucleation and secondary expansion of the breast tissue are often sufficient to restore breast symmetry but sometimes, as in the two cases presented, reconstruction is necessary.

Adolescent↗
PubMed1995

Inhibition of nitric oxide synthase reduces Sephadex-induced oedema formation in the rat lung: dependence on intact adrenal function.

In the present study we have investigated the effect of L-nitro arginine mono methyl ester (L-NAME), an inhibitor of nitric oxide (NO) synthase on Sephadex induced inflammation in the rat lung. Instillation of Sephadex into the airways induced an inflammatory reaction characterized by a long-lasting interstitial oedema, measured as an increase in lung weight, and an influx of inflammatory cells into the airways. L-NAME given s.c. prevented the increase in lung weight following Sephadex instillation. The inactive enantiomer D-NAME had no effect, nor did aminoguanidine which indicates that this effect of L-NAME was mediated by inhibition of the constitutive form of NOS. Treatment with L-NAME did not reduce an established oedema. In contrast, L-NAME tended to enhance the influx of oesinophils into the airways of Sephadex-instilled animals. L-NAME did not have any effect on the development of oedema in adrenalectomized rats or in animals where formation of glucocorticosteroids (GCS) was inhibited with metyrapone. L-NAME did not however, increase plasma levels of corticosterone. The present results indicate that, in this model, inhibition of NO-synthesis has marked anti-inflammatory effects. The underlying mechanism is complex but seems not to involve prevention of overproduction of NO.

Adrenal Glands↗
PubMed1995

Disturbed anabolic hormonal patterns in burned patients: the relation to glucagon.

OBJECTIVE: Complex changes in the anabolic regulators of metabolism occur after major injury. We have studied the time course for IGF-I and IGFBP-1 after burn injury and their relations to circulating levels of other anabolic and catabolic hormones. The hormonal patterns during the onset of sepsis were also investigated. PATIENTS: Eight patients (age 36 (6) years, mean (SEM)) with major burn injury (burn area 42 (6) %) were studied. The first 2 days since the burn were used for rehydration therapy (rehydration period), after which a complete total parenteral nutrition (TPN) period was initiated. Seven positive blood cultures, during the study period. Six of the eight survived. MEASUREMENTS: The hormonal changes determined in the morning during the first 7 days after the burn and from day 22 to 24 were investigated. The superimposed effects of sepsis were studied by normalizing all data to the day of positive blood cultures and clinical onset of sepsis. RESULTS: On admission, plasma levels of glucagon, IGFBP-1 and GH were elevated while levels of IGF-I were low. During the first week after the burn, morning levels of glucagon and insulin increased while levels of GH and IGF-I decreased. GH levels were still elevated compared to healthy subjects. Despite the increase in insulin levels, IGFBP-1 remained elevated. Three weeks after the burn injury, IGF-I levels were increased but still markedly below normal, while IGFBP-1 levels remained unchanged. Persistent elevations of insulin levels were combined with reductions in glucagon levels. Admission levels of IGFBP-1 correlated to nitrogen loss (negative nitrogen balance) during the first 24 hours after the burn (r = 0.84, P < 0.05). A correlation between negative nitrogen balance and glucagon levels was found during early catabolic period in the rehydration period (i.e. days 2-3, r = 0.84, P < 0.01). The relative change in IGFBP-1 levels in the rehydration period correlated to changes in glucagon levels (days 2-3 vs admission, r = 0.85, P < 0.05). The insulin/glucagon molar ratio correlated to the IGF-I/IGFBP-1 ratio during both the rehydration period (days 2-3, r = 0.77, P < 0.05) and the third week after the burn (r = 0.77, P < 0.05). During the most catabolic phase in the first week after the burn (TPN period) there was an inverse relation between IGF-I and IGFBP-I and glucagon (r = 0.83, P < 0.05). During the less catabolic third week after the burn, an inverse correlation was found between IGF-I and glucagon (r = -0.83, P < 0.05). Sepsis, superimposed upon the burn trauma, was associated with transient elevations in IGFBP-1 and reductions in insulin despite elevated levels of glucose and a further 50% increase in nitrogen losses. CONCLUSIONS: The present findings show that marked changes is important anabolic regulating factors occur after major burn injury. Uncoupling of the GH-IGF-I axis, and the attenuation of the inhibitory effects of insulin on IGFBP-1, both contribute to the reduction in IGF-I levels and bioavailability, factors which may play an important role in post injury metabolism. Furthermore, these data suggest that the catabolic hormones (catecholamines, cortisol and glucagon), primarily glucagon seem to be involved in the modulation of IGF-I and IGFBP-1 levels following burn injury.

Adult↗
PubMed1994

Skin thickness in expanded human breast skin.

By means of an ultrasonic technique, skin thickness was measured in 13 women subjected to mammary reconstruction by tissue expansion. Measurements were performed the day before introduction of the expander, after the last inflation, the day before introduction of the permanent implant, and at 2 weeks and 6 months after this operation. Five patients had their expanders inflated every day (rapid expansion), and 8 patients, once a week (slow expansion). A decrease in skin thickness during the inflation period was recorded, and this decrease was permanent even 6 months after the second operation. After exchange of the expander for a permanent implant, there was a transient statistically significant increase in skin thickness. There was no statistical difference between the groups of rapid and slow expansion.

Adult↗
PubMed1993

Calcitonin gene-related peptide increases the blood flow of port-wine stains and improves continuous-wave dye laser treatment.

Ten patients with port-wine stains were treated with continuous-wave dye laser before and after treatment with the vasodilatory compound calcitonin gene-related peptide. The patients were given calcitonin gene-related peptide as an intravenous infusion or as a regional intravenous infusion. Six uniformly colored test sites, each 5 x 10 mm, located within a port-wine stain were selected for clinical evaluation. Laser treatment of these areas was performed on one occasion with three different energy densities: 15, 30, and 45 J/cm2. The port-wine stain circulation was monitored with a laser Doppler flowmeter before and after calcitonin gene-related peptide infusion and immediately after laser treatment. The cosmetic result was evaluated and judged as excellent, desirable, or undesirable. It was shown that calcitonin gene-related peptide is able to induce a long-lasting increase in blood flow in the vascular bed of port-wine stains and that the immediate postlaser laser Doppler flow values may serve as an indication of the outcome of laser therapy. The cosmetic result was often better in the group treated with calcitonin gene-related peptide compared with controls, and an excellent result also was achievable with the use of lower levels of energy.

Adult↗
PubMed1992

Electrical nerve stimulation improves healing of diabetic ulcers.

A controlled study of the effects of electrical nerve stimulation (ENS) was performed in conjunction with a standard treatment for healing chronic diabetic ulcers on 64 patients divided randomly into two groups. All patients received standard treatment (paste-impregnated bandage and a self-adhesive elastic bandage) plus placebo ENS or ENS (alternating constant current; frequency, 80 Hz; pulse width, 1 msec; intensity-evoking strong paresthesias) for 20 minutes twice daily for 12 weeks. Comparison of percentages of healed ulcer area and the number of healed ulcers was made after 2, 4, 6, 8, and 12 weeks. There were significant differences (p < 0.05) in both ulcer area and healed ulcers in the ENS group compared with the placebo group after 12 weeks of treatment. The results of the present study support the use of ENS in diabetic ulcers. ENS is easy to apply and can be used by the patient at home following instructions from a medical doctor or a therapist experienced in electrical stimulation and the treatment of ulcers. Additional studies are needed to identify the mechanisms involved in the promotion of ulcer healing with electrical stimulation and to determine the stimulus variables that most efficaciously accelerate tissue repair.

Aged↗