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Biomedical subjects

R Hallgren

Publications and source records attributed to R Hallgren.

11 recordsLinked to original sources
PubMed1995

Timing of repair of congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation support.

Treatment of congenital diaphragmatic hernia (CDH) has undergone a revolutionary change in philosophy, from previous urgent repair to the present practice of stabilization and delayed repair. However, when extracorporeal membrane oxygenation (ECMO) is required, many people believe that the risk of postoperative pulmonary hypertension (PPHN) mandates hernia repair while on ECMO. This report details the experience in two ECMO centers with stabilization, ECMO if required, and CDH repair post-ECMO. All CDH patients symptomatic in the first hour of life with a gestational age of at least 34 weeks during the period were reviewed retrospectively. Standard criteria were used to select patients for ECMO. High-frequency jet or oscillating ventilators and nitric oxide were not routinely available throughout the study period, but were used in some of the more recent patients. A total of 60 patients presented to the two centers; 24 cases were stabilized with conventional management, repair of the CDH was done elective, and survival was 100%. Eight patients were referred after having repair elsewhere; six survived (75%). The two deaths were attributable to associated lethal lesions--complex cyanotic heart disease and alveolar capillary dysplasia. Eight patients who required ECMO were managed with the intention of repairing the defect on ECMO. Four survived (50%). Two patients died before repair. Twenty patients were managed with ECMO, with the intention of repairing the defect after decannulation. Overall survival was 13 (65%), deaths were caused by pre-ECMO hypoxia, pulmonary insufficiency, and associated cardiac disease. No patient had recurrent pulmonary hypertension after late repair.(ABSTRACT TRUNCATED AT 250 WORDS)

Capillaries↗
PubMed1993

The current and future role of the nurse in phlebology: the Canadian experience.

Sclerotherapy treatment of varicose and telangiectatic leg veins is becoming a popular treatment in North America. Since the tools for performing this treatment are inexpensive and readily available, many health care practitioners are performing this technique with variable states of expertise and outcome. Understanding the professional and ethical issues facing phlebology nurses in Canada can enhance the care of phlebology patients in the United States.

Canada↗
PubMed1992

Neonatal congenital diaphragmatic hernia and extracorporeal membrane oxygenation.

OBJECTIVE: To describe the outcome of infants with congenital diaphragmatic hernia (CDH) presenting early who were referred for possible extracorporeal membrane oxygenation (ECMO). DESIGN: Retrospective descriptive study. SETTING: Neonatal Intensive Care Unit of the Royal Alexandra Hospital, Edmonton. PATIENTS: Fifteen infants referred to our program since its introduction, in February 1989; 13 received ECMO. The criterion for ECMO was the presence of an oxygen index of more than 40 on three occasions within 2 hours. INTERVENTION: ECMO was performed by means of cannulation of the right carotid artery and jugular vein for 111.0 hours on average. RESULTS: In 5 of the 13 infants who underwent ECMO the procedure was performed after surgical repair; all were successfully weaned off ECMO, and the cannula was removed without incident. In the remaining eight ECMO was started before surgical repair; of the six who received it during repair four ultimately survived. None of the previously described predictors of outcome for CDH, including diagnosis before 25 weeks' gestation (in six cases), were useful in determining the survival of the patients. Bleeding was the most common complication and cause of death. CONCLUSION: ECMO is associated with survival in infants with CDH who fail to respond to conventional therapy and who have a poor prognosis according to previously established criteria.

Extracorporeal Membrane Oxygenation↗
PubMed1992

Increased intestinal permeability in active pulmonary sarcoidosis.

Altered permeability of the gut is a well-described feature in Crohn's disease. Because of pathologic similarities between Crohn's disease and sarcoidosis, we initiated this study to evaluate the permeability of the gut mucosal lining in patients with pulmonary sarcoidosis. A group of 18 patients with biopsy-proven pulmonary sarcoidosis (active n = 8, inactive n = 10) were included in the study. Control groups included 22 patients with Crohn's disease (active n = 12, inactive n = 10), nine untreated patients with recent pulmonary tuberculosis, six patients with coal worker's pneumoconiosis (CWP), eight patients with idiopathic pulmonary fibrosis (IPF), and 16 healthy subjects. All were nonsmokers. The 24-h urinary excretion of 100 microCi 51Cr-ethylenediaminetetraacetic acid (51Cr-EDTA) was used to test the intestinal permeability (IP). As previously demonstrated, patients with active Crohn's disease demonstrated a dramatic increase in IP (7.7 +/- 1.4%) that was clearly reduced in inactive CD (2.34 +/- 0.54%). Patients with active pulmonary sarcoidosis exhibited a marked increased IP to 51Cr-EDTA (4 +/- 0.54%), which was not found in patients with inactive sarcoidosis (1.6 +/- 0.17%). IP was normal in patients with pulmonary tuberculosis (1.03 +/- 0.25%), CWP (2.1 +/- 0.54%), and IPF (1.9 +/- 0.33%) and did not differ from the control group (1.76 +/- 0.23%). In addition, in 6 patients with active pulmonary sarcoidosis, the concentrations of albumin and hyaluronan were measured in jejunal perfusion fluid and compared with those obtained from 10 patients with active Crohn's disease and 16 control subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Albumins↗
PubMed1979

Current status of the peritoneovenous shunt for the management of intractable ascites.

Renewed interest in the management of intractable ascites has led to the use of a peritoneovenous shunt for its control. Analysis of Canadian experience with this technique in the last 2 years has demonstrated that there are problems associated with it that have not been reported in the surgical literature. A group of 60 patients who underwent peritoneovenous shunting at several Canadian centres was analysed. The operative mortality was 20% but was related to the underlying disease rather than to the operative procedure. Although the initial response to shunting was excellent in 53%, long-term patency (more than 3 months) was achieved in only 43%, but the procedure greatly improved the quality of life in those patients. The indications for shunting, the complications, results and cumulative patency rates are discussed.

Adult↗