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Biomedical subjects

R Wallensten

Publications and source records attributed to R Wallensten.

At least 19 recordsLinked to original sources
PubMed2004

Minimizing factor requirements for surgery without increased risk.

The most common type of surgical procedure in patients with haemophilia is orthopaedic surgery on the lower limb. These procedures are of great importance for the improvement of the function and quality of life of patients with haemophilia, but in many countries resources are lacking to provide the factor concentrates needed for these operations. We have attempted to reduce the level of replacement during and after total hip or total knee replacement without jeopardizing the outcome of the procedures. The results from 30 operations in 27 patients are presented. Steady-state levels down to 0.5 IU mL(-1) did not appear to increase the amount of blood loss or cause an increased incidence of complications, compared with higher levels. In addition, we review the possibilities to reduce the amount of factor concentrate by performing a combination of orthopaedic procedures and using local haemostatic agents or antifibrinolytic agents.

Aged↗
PubMed2000

The Wagner revision prosthesis consistently restores femoral bone structure.

The short-term results are reported for 43 hip revision operations with the long-stemmed Wagner prosthesis. The patients were followed-up for an average of 25 months. The Charnley scores were; pain 5.2, movement 4.0 and walking 4.0. All patients except one showed abundant new bone formation. The stem subsided more than 20 mm in 5 patients and in 22 the subsidence was less than 5 mm. The major complication was dislocation, which occurred in 9 patients; 8 of these were reoperated and from then on remained stable.

Aged↗
PubMed1999

Efficacy of a high purity, chemically treated and nanofiltered factor IX concentrate for continuous infusion in haemophilia patients undergoing surgery.

We have evaluated the haemostatic efficacy of plasma derived, highly purified, solvent-detergent treated factor IX concentrate (Nanotiv), to which a nanofiltration step has recently been added to improve safety with regard to parvovirus B19, hepatitis A and other nonlipid enveloped viruses. Thirteen surgical procedures, including eight orthopaedic operations, were carried out using continuous infusion of Nanotiv in 10 haemophilia B patients (nine severe and one mild). Tranexamic acid was used for 11 of the 13 procedures. The mean factor IX levels on the day of surgery and postoperative days 1-3 were 0.77, 0.89, 0.80 and 0.73 IU mL(-1), respectively. The haemostatic effect was rated as normal or excellent and no blood transfusions were needed. One patient had thrombophlebitis twice at the infusion site. The remaining cases received heparin, 5 units per 100 IU of Nanotiv, and had neither superficial nor deep venous thromboembolic complications. The requirement for factor IX in the four joint replacement operations was 663 IU kg(-1) during the first 9 days, which compares favourably with previous materials. Thus, continuous infusion with this highly purified factor IX concentrate with improved viral safety is effective for surgery in haemophilia B.

Adolescent↗
PubMed1999

The Kessel total shoulder arthroplasty. A 13- to 16-year retrospective followup.

Between 1982 and 1985, 23 Kessel total shoulder arthroplasties were performed on 22 patients with rheumatoid arthritis. A clinical and radiographic review of the 5-year experience was evaluated in 1988 and published in 1992. Ten years later a followup study was done. Of the 22 patients, 11 have died and two were seriously ill and could not participate. Of the remaining nine patients, one had revision surgery after 2 years, leaving eight patients with a mean age of 61 years for this followup study. Shoulder function was evaluated subjectively using the Simple Shoulder Test, and pain was evaluated using a visual analog scale. New radiographs were taken. In general, the patients had a low functional level, but they were able to sleep on the surgically treated side and to manage daily hygiene. Five patients were pain free, and the worst recorded pain during the day was 35 mm on the visual analog scale. Two patients had their scapular component cemented at primary surgery. The radiographs showed no radiolucent zones around these components. The six other scapular components had radiolucent zones of 1 to 3 mm. No radiolucent zones were detected around the humeral components.

Activities of Daily Living↗
PubMed1997

Can we predict the outcome of a partial rupture of the anterior cruciate ligament? A prospective study of 43 cases.

The concept of partial rupture of the anterior cruciate ligament (ACL) has been confirmed by arthroscopic examination and palpation. We present a prospective study of 43 patients who were diagnosed arthroscopically as suffering from a partial rupture of the ACL by the same surgeon. The patients followed a rehabilitation protocol and were examined by an independent observer after 5 years. Twenty-five patients had a stable knee, whereas 18 eventually suffered a complete ACL rupture. ACL partial rupture is easily recognizable with arthroscopy, but the quantity and state of the still intact fibres is difficult to assess.

Adolescent↗
PubMed1993

Surgical treatment of patellar tendinitis.

Patellar tendinitis is an overuse syndrome affecting the origin of the patellar tendon and its underlying part. Ultrasonography is useful to investigate tendinous pathology. It describes the anatomical lesions and their extent. Surgical excision of irreversible lesions, demonstrated on ultrasonography, is a logical attitude which provides good results.

Adult↗
PubMed1992

The Kessel prosthesis in total shoulder arthroplasty. A five-year experience.

Between 1982 and 1985, 23 Kessel total shoulder arthroplasties were performed on 22 patients. A clinical and roentgenographic review was performed by an independent observer. Three patients had their prostheses removed and three had revision surgery, leaving 17 shoulders in 16 patients available for study, all with rheumatoid arthritis (RA). All patients were relieved of pain and noticed a general improvement in activities of daily living. Passive flexion and rotation were increased, but active movements remained unchanged. Roentgenographically, radiolucent zones developed around the scapular component on all patients within one year but only around one of the humeral components. Total shoulder arthroplasties with the Kessel prosthesis in RA relieved pain and improved shoulder and arm function. The long-term results were complicated by a high incidence of loosening of the glenoid component, probably a feature of the constrained design of the Kessel prosthesis.

Adult↗
PubMed1992

Should the glenoid be replaced in shoulder arthroplasty with an unconstrained Dana or St. Georg prosthesis?

Twenty-six patients, 11 with rheumatoid arthritis and 15 with osteoarthritis, have been operated on with an unconstrained total shoulder arthroplasty. Mean follow-up was 47 months. Three prostheses have been extracted. All patients stated that they had pain relief after surgery. At three year follow-up all except one had developed radiolucent zones around the glenoid component. No zones were observed around the humeral component. In shoulders with preserved glenoid surface replacement of only the humeral head might provide better long-term results than a total shoulder arthroplasty.

Adult↗
PubMed1990

Shoulder function after prosthetic replacement of proximal humerus.

Between 1973 and 1985 eighteen patients with bone tumours and two patients with comminuted fractures had their proximal humerus replaced with a custom made isoelastic hemiendoprosthesis. In 1987 a clinical and radiographical review was performed of eleven patients with a mean follow up time of seven years, range 3-10 years. Four patients had pain at rest and six patients experienced severe pain on exertion. Active range of motion was poor and constituted only half of the corresponding range of passive motion. Shoulder girdle muscles were generally weak, only one patient could keep the arm straight in a flexed or abducted position. All patients had returned to their previous occupations, but their ability to perform ADL functions was poor. Rotator cuff insufficiency was considered to be the major cause of poor shoulder function. In comparison to most other surgical alternatives in tumour cases endoprosthetic replacement of the proximal humerus appears to be a safe and reliable method. The endoprosthesis gives stability to the arm and normal elbow and hand function is preserved.

Adult↗
PubMed1988

Venous circulation after fasciotomy of the lower leg in man.

The study was performed in order to evaluate the effect of fasciotomy of the lower leg on venous circulation and venous muscle pump function. Twenty patients with unilateral fasciotomy were investigated with photoplethysmography (PPG), strain-gauge plethysmography, foot volumetry and Doppler ultrasound. In the operated legs shorter venous refilling times were registered both with PPG (P less than 0.01) and foot volumetry (P less than 0.05). PPG recordings from different parts of the leg showed regional changes in venous circulation with shorter refilling times only with the transducer placed over the affected muscular compartment. With foot volumetry a reduced expelled volume was found in patients earlier treated with extensive fasciotomies. The results of the study indicate that an intact muscle fascia is of importance for venous return and venous pump function.

Adolescent↗
PubMed1984

Intramuscular pressures in exercise-induced lower leg pain.

Intramuscular pressures were measured in 12 patients with symptoms of medial tibial syndrome and in 12 patients with chronic anterior compartment syndrome. Measurements were performed with the wick catheter technique simultaneously in the deep posterior and the anterior tibial muscle compartments before, during, and after exercise. In the deep posterior compartment there was no pressure increase during or after exercise as compared to controls in either patient group. However, a significant pressure increase was present in the anterior tibial compartment during and after exercise in the patients with chronic anterior compartment syndrome as compared to normal resting values. The medial tibial syndrome patients demonstrated in the anterior tibial muscle compartment, exercise and post-exercise pressures, which were between those of the healthy controls and the chronic anterior compartment syndrome patients. The so-caLled medial tibial syndrome is probably not a compartment syndrome in the deep posterior muscle compartment. Intramuscular pressure measurement is a valuable tool in diagnosing a chronic compartment syndrome and in selecting patients in whom fasciotomy of the affected compartment is indicated.

Adolescent↗
PubMed1984

Histochemical and metabolic changes in lower leg muscles in exercise-induced pain.

Intramuscular pressure, fiber type distribution, relative cross-sectional area of slow-twitch muscle fibers, muscle lactate, and water content were studied in eight patients with medial tibial syndrome and in eight patients with chronic anterior compartment syndrome. The variables were determined before and after standardized exercise that provoked lower leg pain. In patients with medial tibial syndrome, the intramuscular pressures in the deep posterior compartment were not elevated before or 10 min after exercise. In patients with chronic anterior compartment syndrome, there was a significant post-exercise increase from 9 +/- 9 to 48 +/- 35 mmHg (P less than 0.01) in the anterior tibial compartment. The patients with medial tibial syndrome and chronic anterior compartment syndrome had a predominance of slow-twitch fibers in the deep posterior (69% and 77%, respectively) as well as in the anterior tibial (69% and 80%, respectively) compartments. The slow-twitch muscle fibers covered less cross-sectional area than could be expected from the fiber composition. Muscle lactate concentration did not increase after exercise in any of the patient groups in contrast to the healthy controls in whom there was an increase (P less than 0.05). The lactate change ratio (post-exercise/pre-exercise) correlated negatively to the percentage of slow-twitch muscle fibers (P less than 0.05) in the patients but not in the healthy controls. Muscle water content increased for both patient groups in the anterior tibial but not in the deep posterior compartment. The findings indicate that the chronic anterior compartment syndrome is related to changes on the muscle fiber level and to a subsequently changed anaerobic metabolism and fluid infiltration.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Intramuscular pressures and muscle metabolism after short-term and long-term exercise.

Intramuscular pressures were measured in the anterior tibial and deep posterior muscle compartments in eight healthy individuals before, during, and after short-term exercise and in 38 individuals after long-term exercise by the wick catheter method. Muscle biopsies were also taken and analyzed for muscle fiber distribution, water content, and lactate content. There were no elevations of the intramuscular pressures in the anterior tibial and the deep posterior muscle compartments after exercise nor was there any evidence of edema or anaerobic metabolism in the muscles examined.

Exercise Test↗
PubMed1983

Results of fasciotomy in patients with medial tibial syndrome or chronic anterior-compartment syndrome.

I studied the results of fasciotomy of the affected muscle compartment in eight patients with chronic anterior-compartment syndrome (involvement of the anterior tibial compartment) and in nine patients with medial tibial syndrome (involvement of the deep posterior compartment), all of whom had pain with exercise. In the patients with chronic anterior-compartment syndrome, the preoperative intramuscular pressure in the anterior tibial compartment, as measured by the wick-catheter method, was increased ten minutes after exercise to 52 +/- 36 millimeters of mercury. After fasciotomy this pressure was significantly lowered to 4 +/- 6 millimeters of mercury (p less than 0.01). In the patients with medial tibial syndrome, the preoperative intramuscular pressure in the deep posterior compartment was normal ten minutes after exercise (8 +/- 4 millimeters of mercury) and did not significantly change after the fasciotomy (5 +/- 6 millimeters of mercury). The clinical results after fasciotomy were good in both groups of patients. There was complete relief of pain in all of the patients with chronic anterior-compartment syndrome and in five of the nine patients with medial tibial syndrome. The other four patients considered their condition to be improved in spite of some remaining symptoms.

Adolescent↗
PubMed1983

Acetabular dysplasia in the adult.

Twenty adults (32 hips) with acetabular dysplasia were followed up for an average of 22 years to determine the natural history of the disorder. Initially, all hips had a center-edge (CE) angle of Wiberg of 20 degrees or less and an essentially intact Shenton's line with no roentgenographic evidence of osteoarthritis. Average patient age initially was 43 years (range, 27-57 years) and at final follow-up examination, 65 years. Various parameters of hip integrity were measured, including the CE angle of Wiberg, acetabular angle of Sharp, percentage of the femoral head covered by the acetabulum, acetabular depth, and inclination of the lateral lip of the acetabulum. None of these indicators proved a reliable prognostic aid for predicting the rate at which the osteoarthritis process supervened in any one case.

Adult↗