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Biomedical subjects

P Olofsson

Publications and source records attributed to P Olofsson.

88 records · Page 5Linked to original sources
PubMed1986

Effects of beta 1-adrenoceptor blockade in the treatment of hypertension during pregnancy in diabetic women.

The effects of beta 1-blockade were investigated in 18 hypertensive pregnant diabetic women. The same women served as controls, covering a period just before therapy. The blood pressure was reduced in 14 women (p less than 0.01). The change in blood glucose homeostasis was statistically not different from the control period. Insulin doses were not affected. The fetal heart rate was affected by therapy, causing a decrease in baseline rate (p less than 0.05) and in acceleration amplitude (p less than 0.05). Although the incidence of suspect fetal distress, intrauterine growth retardation and preterm delivery was high, all surviving infants had normal Apgar scores at 5 and 10 min. Perinatal mortality consisted of one stillbirth. Except for respiratory problems, the incidence of neonatal complications was low. All survivors were healthy at follow-up. We found beta 1-blockade to be effective and safe in this group of high-risk pregnancies, and suggest it as an alternative for anti-hypertensive therapy in diabetic pregnancy.

Adult↗
PubMed1986

Fetal distress during labour in diabetic pregnancy.

The frequency of fetal distress in labour was studied in 46 diabetic women and in 46 non-diabetic matched controls. Fetal distress was assessed by electronic fetal heart rate (FHR) monitoring and fetal scalp blood pH determinations in late first stage of labour. Ominous FHR and/or low pH (less than 7.26) was more common in the diabetic group than in the control group (17.4% and 10.9%, respectively) but the difference was not statistically significant. The frequency of caesarean section and low Apgar score at 1 min was significantly higher in the diabetic group (P less than 0.05). There was no correlation between maternal blood glucose regulation and the occurrence of fetal distress in the diabetic group. The results suggest that fetal distress may be slightly more common in labour in diabetic women compared with controls managed in a similar way. Careful FHR monitoring and liberal use of fetal scalp blood pH determinations is recommended.

Adult↗
PubMed1986

Application of a quantitative spectrophotometric endotoxin assay on lymph and plasma from the rat.

A quantitative spectrophotometric assay for endotoxin, utilizing Limulus amebocyte lysate and a chromogenic peptide substrate, was standardized for the application on lymph and plasma from the rat. The influence of inhibitors and unspecific amidolytic activity, the optimal incubation times, the adhesion of endotoxin to platelets and glass surface, the variation in endotoxin standard as well as the effects of cold storage on endotoxin activity were settled. In vitro added as well as endogenously derived endotoxin was studied. The method was found to be reliable when in practical use on these media.

Animals↗
PubMed1986

Fetal surveillance in diabetic pregnancy. I. Predictive value of the nonstress test.

Ninety-nine consecutive diabetic pregnancies (101 infants) were monitored with altogether 2672 nonstress tests (NSTs) from about 30 weeks of gestation until parturition. In 96% of the women the last NST was performed within 2 days of delivery. Fifty-nine percent had normal NSTs throughout pregnancy. Only 3.7% of the 2 672 tests were classified as pathological. When performed within 2 days antepartum, a normal NST predicted the 1-min Apgar score to be greater than or equal to 7 in 92%, and at 5 and 10 min in 99%. When all NSTs ever performed were included, the predictive value improved to 100%. The baby's first cry within 1 min after birth was predicted in 96%. Furthermore, the predictive value of a normal NST regarding the absence of ominous intrapartum cardiotocographic (CTG) patterns, normal pulmonary function and normal metabolic balance, was about 80%. The perinatal mortality was 1%. The specificity was in general good (86-96%), whereas the predictive value of pathological tests and the sensitivity almost without exception were poor. It is concluded that the very low rate of pathological NSTs indicates that obstetric interventions were made soon after the occurrence of the first sign of fetal jeopardy. Only then, and with meticulous care, is it possible to obtain good results. A normal NST is an excellent predictor of a normal Apgar score at 5 and 10 min, and also very good for a normal 1-min Apgar and an early cry from the baby. The predictive value is quite acceptable concerning the intrapartum CTG and the neonatal course likewise regarding the pulmonary function and metabolic balance.(ABSTRACT TRUNCATED AT 250 WORDS)

Apgar Score↗
PubMed1986

Fetal surveillance in diabetic pregnancy. II. The nonstress test versus the oxytocin challenge test.

At the Department of Obstetrics and Gynecology, University of Lund, it has been the routine management in diabetic pregnancy to use both nonstress test (NST) and oxytocin challenge test (OCT) for fetal surveillance. The study material reported comprised 61 pregnant diabetics, 1,882 NSTs and 90 OCTs. Evaluations were made separately for the time interval 0-2 days antepartum, within 1 week antepartum, and all tests included. Predictive value, specificity and sensitivity were calculated for both the NSTs and the OCTs according to the following variables of neonatal outcome: Apgar scores at 1, 5 and 10 min, baby's first cry (or not) within 1 min of birth, pulmonary function, and metabolic balance. No perinatal deaths occurred. There were no statistically significant differences between the NSTs and OCTs in the antepartum time intervals 0-2 days and less than or equal to 1 week regarding any variable. When all tests were included, the OCT proved superior in that there were fewer falsely pathological tests, though biased by the fact that most of the NSTs evaluated were older than the oldest OCT in this context. Nevertheless, it is concluded that the OCT does not favor the NST for routine fetal surveillance in diabetic pregnancy.

Apgar Score↗
PubMed1985

Twin delivery: how should the second twin be delivered?

In a series of 803 pairs of twins born between 1973 and 1982, 0.33% of second twins were delivered by cesarean section after vaginal delivery of the first twin. During the last year the frequency has increased to 7%, calling attention to the problem of declining obstetric skills and experience. This has caused us to update the routines of intrapartum management of twin gestations. In the present program only commonly available obstetric techniques are used. The potentially hazardous twin delivery is excluded from a trial of vaginal delivery. Hopefully, the program will help other obstetricians to decide in favor of vaginal delivery in selected twin gestations.

Breech Presentation↗
PubMed1985

Classification of the nonstress test and fetal outcome in 1,056 pregnancies.

During a 2 1/2-year period, 1 056 pregnant women (1 072 fetuses) were monitored with the nonstress test (NST) in the antenatal period. Testing time was 30 minutes. The NST was classified into one of four classes: normal, suspect pathological, slight pathological, and severe pathological. In 88.5% of the pregnancies, all NSTs were normal. Suspect, slight, or severe pathological NSTs occurred at least once in 8.1%, 2.1%, and 1.3% of the women respectively. All women with a severe pathological NST had high-risk complications. Lethal malformations excluded, there were only two perinatal deaths among the tested women. In the four different classes, the frequencies of cesarean section were 11%, 17%, 41%, and 79%. One-minute Apgar scores were less than 7 in 5%, 12%, 41%, and 64%. The need for referral to neonatal intensive care was 19%, 40%, 41%, and 93% respectively. A normal NST predicted normal fetal outcome in an excellent way, while the three pathological classes appeared to represent different degrees of impending fetal jeopardy.

Apgar Score↗
PubMed1985

Endotoxin-transport routes and kinetics in intestinal ischemia.

A rat model representing segmental intestinal ischemia was used to study the absorption and transport of endotoxin from the ischemic gut. Serial quantitative analyses were made on peritoneal fluid, thoracic duct lymph and arterial and portal vein blood. Significantly increased endotoxin concentrations were found in thoracic duct lymph before transmural leakage took place. After leaking through the devitalized intestinal wall, endotoxin was transported by both lymphatic and portal routes. Kinetic analysis revealed that systemic endotoxemia paralleled the appearance of endotoxins in thoracic duct lymph, preceding a significant increase in the portal vein. The amount transported by the portal vein never exceeded the proposed endotoxin-filtrating capacity of the liver. In intestinal ischemia, consequently, systemic endotoxemia appears to be mediated mainly by lymphatic transport.

Animals↗
PubMed1984

Changing panorama of perinatal and infant mortality in diabetic pregnancy.

In a 21-year study covering 1960 to 1980, perinatal and infant mortality in 237 infants of diabetic mothers were analysed. The study was divided into three 7-year periods related to changes in management. In period I (1960-66) the perinatal mortality was 24.3%, decreasing to 5.0% in period II (1967-73) and to 1.1% in period III (1974-80). The corresponding figures for infant mortality were 31.4%, 7.5% and 4.6% respectively. Today the difference between the perinatal mortality rate in diabetic vs. non-diabetic pregnancies is almost negligible. However, perinatal mortality may give a false impression of pregnancy outcome, since owing to the high rate of lethal malformations in period III, infant mortality was still twice that of the non-diabetic population. During the 21-year period studied, complications of diabetic pregnancies such as severity and duration according to the White classification, hypertension and pyelonephritis in pregnancy and preterm delivery all decreased. Consequently the influence of these complicating factors on the overall outcome of diabetic pregnancies has declined.

Congenital Abnormalities↗
PubMedDate not supplied

Increase of fetal hematocrit decreases the middle cerebral artery peak systolic velocity in pregnancies complicated by rhesus alloimmunization.

Our hypothesis for this study was that an increase in fetal hematocrit would decrease the middle cerebral artery peak systolic velocity. Seventeen pregnancies complicated by Rh alloimmunization were included in this study. Middle cerebral artery peak systolic velocity was studied by Doppler ultrasound before and after intrauterine transfusion with adult packed red blood cells (hematocrit = 80-85%). Mean gestational age at time of study was 27 weeks. Paired t-test was used for statistical comparison. A P value of < 0.05 was considered statistically significant. The fetal hematocrit ranged from 5.9% to 30% prior to the procedure, and it was 24.8-53.4%, following the procedure. Mean middle cerebral artery peak systolic velocity was 46.2 +/- 10.7 cm/s prior to the procedure, and it decreased to 31.7 +/- 9.5 cm/s following the procedure (P < 0.01). The increase of fetal hematocrit significantly decreases the middle cerebral artery peak systolic velocity supporting data that this Doppler measurement may be useful for the diagnosis of fetal anemia.

Anemia↗
PubMedDate not supplied

Triplet and quadruplet pregnancies--a forthcoming challenge also for the 'general' obstetrician.

Data from 14 triplet and 2 quadruplet pregnancies (50 infants) during the period 1974-1988 were analysed. The perinatal mortality rate was only 6%, despite a preterm delivery rate of 88%. Preterm delivery was more common in young (less than or equal to 29 years) multiparous women. Perinatal complications were, as expected, strongly associated with immaturity. Respiratory problems of the infants occurred significantly more often among women delivered by elective Cesarean section than among those planned for vaginal delivery, but the mean gestational duration was 1 week longer in the latter group. Few problems arise in infants weighing 2000 g or more, or at delivery at 34 weeks or later, and under optimal conditions it would therefore seem safe to allow these women to give birth vaginally. Nor did birth order affect the outcome for infants born vaginally. It is recommended that quadruplets be delivered by Cesarean section because of the difficulty of ensuring satisfactory fetal surveillance in labor.

Adult↗
PubMedDate not supplied

MR imaging of complications of aortic surgery.

Sixteen patients with a variety of complications of aortic surgery were evaluated with magnetic resonance (MR) imaging. More than one complication occurred in seven patients, resulting in the following types of abnormalities: graft occlusions, two; graft infections; five; pseudoaneurysms or aneurysmal dilatation of graft anastomoses, 10; perigraft hemorrhages, four; and aortoenteric fistulas, two. The MR findings were verified by surgery in 10, by CT in four, and by angiography in 11 patients. The size and extent of pseudoaneurysm or anastomotic dilatation, the presence of thrombus and vessel occlusion, the extent of abscesses, and the effect of pseudoaneurysms and abscesses on adjacent structures were readily demonstrated by MR. The size of the residual lumen in the case of thrombosis could be assessed. Abscesses were identified by their characteristic signal increase with long repetition rates and long echo delays. Magnetic resonance was also able to exclude suspected complications such as perigraft infection, hemorrhage, and graft occlusion in four patients.

Abscess↗
PubMedDate not supplied

Femoro-popliteal and femoro-distal bypass: a comparison between in situ and reversed technique.

The present report compares the in situ technique with that using the reversed vein for femoropopliteal bypass. In 1986 the in situ technique was introduced at our clinic as the preferred method for femoropopliteal bypass with the lower anastomosis below the knee or femorodistal bypass. Forty patients operated with the in situ technique were compared with an equal number of patients operated with the reversed technique 1983-1985. The two groups were comparable regarding concomitant cardiovascular and pulmonary disease, preoperative ankle-brachial index and level of distal anastomosis. Patency after 6 months was significantly higher (84%) for the in situ grafts compared to reversed veins (49%). The difference was mainly caused by a significantly higher patency for in situ grafts anastomosed to infrapopliteal arteries. Despite better patency rates in the in situ group limb salvage at 6 months was the same in both groups. Operating time was also similar in both groups. It is concluded that the in situ technique is superior to the reversed technique, at least in infrapopliteal reconstructions. The superior patency rate and the technical advantages without apparent disadvantages are the basis for the recommendation to use the in situ technique for femoropopliteal and femorodistal bypass.

Aged↗
PubMedDate not supplied

Evaluation of the effects of lymph drainage by a thoracic duct fistula in experimental peritonitis.

Previous studies suggest that systemic endotoxemia in peritonitis is mainly related to lymphatic transport via the thoracic duct. Rats with fecal peritonitis but with or without a lymph draining thoracic duct fistula were studied with reference to the concentrations of endogenously produced endotoxin in arterial plasma, hemodynamic parameters, organ blood flow, blood corpuscle parameters, glucose and lactate metabolism and survival. Lymph drainage significantly reduced the endotoxin concentrations in arterial plasma, but did not totally prevent systemic endotoxemia, and was related to maintained total peripheral vascular resistance. On the other hand, peritonitic rats without lymph drainage, and consequently higher endotoxin concentrations, had a significant fall in vascular resistance combined with a compensatory rise in cardiac output. Lymph drainage also contributed to a smaller decrease of platelet and leucocyte counts while no effect was observed on glucose metabolism. Despite the effect of lymph drainage on hemodynamic and hematologic responses no effect on survival time was recorded.

Animals↗