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Biomedical subjects

S Bergman

Publications and source records attributed to S Bergman.

At least 19 recordsLinked to original sources
PubMed2005

Does aggressive hydration reverse the effects of pneumoperitoneum on renal perfusion?

BACKGROUND: Although pneumoperitoneum (PP) decreases renal blood flow, it remains unclear whether this impacts renal function. Our aim was to characterize the effects of PP on renal perfusion and function using two fluid strategies for intravenous fluid administration. METHODS: Twelve 30-kg pigs were randomized into two groups: maintenance (3 cc/kg/h of normal saline (NS)) and bolus (15 cc/kg/h + 20 cc/kg NaCl bolus prior to induction of PP). Pigs were studied in a blinded fashion for 30 min prior, 60 min during, and 30 min after release of 15 mmHg CO(2) PP. Cardiac output (CO) and stroke volume (SV) were measured using an esophageal Doppler probe, renal cortical perfusion (RCP) was measured with a laser Doppler probe on the right kidney, and renal function was measured using the fractional excretion of sodium (FeNa) and urine output. Statistical analysis was performed with area-under-the-curve (AUC) analysis and analysis of variance RESULTS: AUC analysis revealed moderate effect size for CO (0.416) and small effect size for SV (0.366) and RCP (0.363), with decreases seen in the control group but not the bolus group. During PP, urine output increased in the bolus group (p = 0.04) but not in the control group; there was no difference in FeNa in either group. CONCLUSION: Aggressive fluid hydration during CO(2) PP of 15 mmHg preserves CO, SV, and RCP while increasing urine output. No effect on renal function as measured by FeNa was observed in either group.

Animals↗
PubMed2005

Relationship between subjective and objective outcome measures after Heller myotomy and Dor fundoplication for achalasia.

BACKGROUND: The purpose of this study is to assess how subjective evaluation (heartburn, dysphagia, quality of life, and satisfaction) correlates with objective data after Heller myotomy and Dor fundoplication for achalasia. METHODS: A total of 53 consecutive patients with achalasia undergoing laparoscopic Heller myotomy and Dor fundoplication were studied prospectively. Subjective evaluation was done preop and postop using the Gastroesophageal Reflux Disease Health-Related Quality of Life instrument (GERD-HRQL; 0 = best, 45 = worse), 4-point dysphagia and heartburn scales (0 = best, 3 = worst), patient satisfaction scale (0 = very satisfied, 5 = incapacitated), and the SF-12 general health-related quality-of-life score. At 3 months postop, patients were asked to undergo objective evaluation with 24-h pH testing, manometry, and endoscopy. Data are expressed as median (interquartile range) and analyzed by Wilcoxon signed rank test or Mann-Whitney U test. RESULTS: Forty-nine patients were more than 3 months postsurgery. Comparing preop to postop, improvements were found in dysphagia [3 (2-3) to 0 (0-1)], heartburn [1 (0-2) to 0 (0-1)], GERD-HRQL [13.5 (6.3-22.5) to 2 (0-5)], satisfaction [3 (3-4) to 1 (0-1)], and SF-12 mental component summary [46 (37-56) to 58 (50-59)] and physical component summary [46 (36-53) to 55 (48-56)] scores (p < 0.0001 for all). Thirty-eight patients (78%) agreed to undergo objective testing, and complete data were available for 32 (65%). Four of 32 patients (12.5%) had evidence of reflux based on 24-h pH testing. Of nine patients with GERD-HRQL >5, only two had positive pH test (22%). Of 23 patients with GERD-HRQL <5, two had positive pH test (7%). Of four tested patients with moderate to severe heartburn, two had an abnormal pH test. There was no significant relationship between GERD-HRQL score and pH test results. Lower esophageal sphincter pressure (LESP) decreased from 24 (16-35) to 13 mmHg (11-17) (p < 0.001). There was no relationship between dysphagia score and postop absolute LESP or a decrease in LESP after operation. CONCLUSIONS: Laparoscopic Heller myotomy and Dor fundoplication is an effective treatment for achalasia. Subjective evaluation can document patient satisfaction and health-related quality of life but does not accurately reflect postop reflux. Twenty-four-hour pH study is required to accurately assess reflux disease.

Adult↗
PubMed2005

Validation of in situ hybridisation and histology assays for the detection of the oyster parasite Marteilia refringens.

An in situ hybridisation technique has been developed for the detection of infection in oysters with Marteilia refringens with particular emphasis on light infections or confirmation of suspected cases by means of histology. Although validation of new diagnostic methods is usually achieved by comparison with standard techniques, in our case the sensitivity and specificity of the standard (histology) had not previously been established. Another point to consider is that surveillance and monitoring frequently target populations displaying different levels of prevalence under different field conditions. The objective of our study was to evaluate the sensitivity and specificity values of in situ hybridisation and histology for the detection of M. refringens, based on 3 populations of flat oysters, free of the disease and with mild and high levels of prevalence. A blind assay of 200 individuals from each population was performed using both techniques. Results were analysed by means of the classical approach and latent models (maximum likehood and Bayesian approach). Assumptions and results were found to vary slightly with the different statistical approaches. The more realistic estimate by the Bayesian approach shows a link between the level of prevalence and the sensitivity of the techniques. Values of sensitivity and specificity for histology were 0.7 and 0.99 respectively, and 0.9 and 0.99 respectively in the case of in situ hybridisation. Some uncertainty remains regarding these values because the study does not take into account the severity of infection or the developmental stages of the parasite actually present in each individual. This work provides valuable information with regard to the choice and potential use of those 2 diagnostic methods currently recommended by international standards.

Animals↗
PubMed2005

Preoperative evaluation of laparoscopic living renal donors with computerized tomography and its effect on donor morbidity and graft function.

OBJECTIVE: To assess the efficacy of CT angiography (CTA) in evaluating the renovascular anatomy in 50 patients who underwent laparoscopic donor nephrectomy, and to correlate results with donor morbidity and recipient outcome. METHODS: Forty-eight patients were evaluated by CTA prior to laparoscopy. Donors with aberrant renovasculature and their respective recipients were divided into: 1) accurate preoperative CTA ("predictive group", PG), 2) inaccurate CTA ("non-predictive group", NPG). Warm ischemia times (WIT), estimated blood loss (EBL), operative time (OT), and the open conversion rate were compared. Recipient creatinine values on post-operative day 1 and 3 months were recorded with the rate of delayed graft function (DGF) and ureteral complication. Statistical significance was calculated using the student's T-test. RESULTS: Among patients with aberrant vasculature (48%, 23/48) at laparoscopy, 14 were accurately predicted by CT angiography (11 arterial, 3 venous). NPG consisted of 5 duplicated arteries, 1 early arterial branching, and 3 anomalous veins. CT accuracy was 85%. The sensitivity and specificity of the arterial imaging were 65% and 100% respectively, while those of venous imaging were 50% and 100%. EBL, WIT, OT, number of open conversions, and ureteral complications were statistically insignificant between groups (p= 0.05, 95% C.I.). The mean decreases in creatinine between NPG and PG on post-operative day 1 and at 3 months were 45.4% and 54.8%, and 71.5% and 79.1% respectively, both statistically insignificant. Two of 8 in the NPG experienced DGF as compared to 1/8 in the PG. CONCLUSIONS: Despite the lower sensitivity of this study, the discordance between imaging and laparoscopy did not augment donor morbidity or increase adverse recipient outcomes. This may indicate that regardless of the shortcomings of 2-D CTA for living donors, it represents a safe and effective imaging modality when coupled with meticulous laparoscopic dissection and central intraoperative involvement of the transplant surgeon.

Angiography↗
PubMed2004

Intraoperative fluid management in laparoscopic live-donor nephrectomy: challenging the dogma.

BACKGROUND: Patients undergoing laparoscopic live donor nephrectomy (LLDN) commonly receive large amounts of fluid intraoperatively to counter the negative effects of pneumoperitoneum on renal function. Our aim is to demonstrate that a low-volume fluid management strategy does not adversely affect donor or recipient outcomes. METHODS: Fifty-two patients underwent LLDN between December 2000 and January 2004. Data were collected in prospective databases, and augmented with retrospective medical record review. Donors were divided into two groups: the fluid-load group (n = 24) received > 10 ml/kg/h of intravenous crystalloids intraoperatively, while the fluid-restriction group (n = 28) received < 10 m/kg/h. RESULTS: Donors in the fluid-restriction group had a lower intraoperative urine output. There were no differences in postoperative creatinine levels (117.5 micromol/L vs 121.5 micromol/L, p = 0.8) or complications (4.2% vs 7.1%, p = 0.9). In the recipients, there were no differences in postoperative creatinine levels up to 12 months, incidence of delayed graft function (18% vs 10%, p = 0.7) or acute rejection (9% vs 5%, p = 1.0) between groups. CONCLUSION: Lower volume fluid management strategies in LLDN do not appear to worsen recipient outcomes nor are they detrimental to the donors.

Adult↗
PubMed2003

Fatal EBV-related post-transplant lymphoproliferative disorder (LPD) after matched related donor nonmyeloablative peripheral blood progenitor cell transplant.

A 39-year-old male underwent a nonmyeloablative stem cell transplant (NMAPBPCT) from his HLA-matched sister for recurrent anaplastic large cell lymphoma in CR-2, receiving fludarabine, cyclophosphamide, and rabbit antithymocyte globulin for the preparative therapy. The patient was readmitted on day+33 for persistent culture-negative fevers. He rapidly developed marked elevations of alkaline phosphatase and bilirubin. Liver biopsy showed a periportal infiltrate of large immunoblastic appearing cells. The tumor cells did not stain for CD3/CD20/CD30 and alk protein, but did stain for CD79a/LCA and CD43. In situ hybridization for Epstein-Barr virus (EBV) RNA (EBER 1) was strongly positive in the periportal infiltrating lymphocytes. Fluorescence in situ hybridization (FISH) studies revealed female (XX) cells in the tumor cells and male (XY) in the surrounding hepatic parenchymal cells. The patient developed severe lactic acidosis, oliguric renal failure and expired on day+44. Both donor and patient had positive IgG serologies for EBV VCA and EBNA pretransplant. The donor also had a positive IgM titer for EBV VCA in the pretransplant specimen. The LPD may have been related to the intense immunosuppression of the preparative therapy and the presence of recent EBV infection in the donor.

Adult↗
PubMed2001

The impact of semantic impairment on word stem completion in Alzheimer's disease.

Both the extent of semantic memory impairment and the level of processing attained during encoding might constitute critical factors in determining the amount of word-stem completion (WSC) priming encountered in Alzheimer's disease (AD) subjects. We investigated the impact of varying encoding level in AD and elderly normal subjects, using a set of stimuli ranked as "intact" or "degraded" in terms of each subject's semantic knowledge on probe questions. For both shallow and deep encoding conditions, overall priming in the two subject groups was equivalent. However, for the deep encoding condition, consisting of a semantic judgment task performed on each target word, the priming effect noted in AD subjects was significantly smaller for semantically degraded items than for semantically intact items. Results indicate that the degree of semantic impairment represents one important variable affecting the amount of WSC priming which results when deep encoding procedures are used at study.

Aged↗
PubMed2001

Cytology of endolymphatic sac tumor.

A 77-year-old man presented with decreased mental status and an enhancing partially cystic tumor along the left tentorium on magnetic resonance imaging after mastoidectomy and petrosectomy for an "auditory canal tumor." Smears of the aspirated cyst fluid revealed rare epithelial cell clusters, some with papillary features, foamy macrophages, and blood. The cells were orderly, with fairly bland nuclei and well-defined cell borders. The cell block contained similar epithelium, with cells containing eosinophilic and focally vacuolated cytoplasm, some with pigmented granules resembling hemosiderin. Numerous foam cells were also present. Review of the patient's previous and concurrent resection material showed an endolymphatic sac tumor, a rare neoplasm that arises in the endolymphatic sac in the temporal bone. The previously undescribed cytologic features of this rare neoplasm are discussed.

Aged↗
PubMed2001

Mitochondrial DNA mutations in black Americans with hypertension-associated end-stage renal disease.

For the majority of hypertensive cases, no gene or combination of genes and environmental factors clearly leading to hypertension has been identified. Studies to identify "hypertension" genes have focused on the assessment of markers and candidate genes in the nuclear genome. In this study, we have chosen to assess the mitochondrial genome as a site of mutations possibly contributing to susceptibility to hypertension in black Americans who have progressed to end-stage renal disease (H-ESRD). The mitochondrial genomes of 58 H-ESRD and 58 normotensive individuals were systematically analyzed by means of a high-resolution restriction analysis. After stratification by the presence or absence of an African continent-specific HpaI site gain at bp 3,592, differences in the frequencies of mitochondrial DNA (mtDNA) restriction variants in both groups were examined by chi-square analyses. A total of six variants was identified with significant differences in one or both cohorts. An A10398G DdeI mutation in the ND3 gene was significantly increased in the H-ESRD cohort (H-ESRD, P = 0.048; normotensives, P = 0.20), as was an HaeIII T6620C/G6260A double mutation in the CO1 gene (H-ESRD, P = 0.05; normotensives, P = 0.48). The remaining four variants were a G2758A mutation in the 16SrRNA gene (identified by RsaI), T10810C in the ND4 gene (identified by HinfI), a G7028A/T7055C double mutation in the CO1 gene (identified by AluI), and finally, a A10086G mutation in the ND3 gene (identified by TaqI; also causing an Asn-->Asp amino acid change). The RsaI and HinfI variants were in strong linkage disequilibrium with the HpaI site and not amenable to further analysis. After correction of all P values for multiple comparisons, the ND3 A10086G (Asn-->Asp) mutation shown by TaqI remained statistically significant (P = 0.0036) in the H-ESRD cohort, not in the normotensive cohort. To the best of our knowledge, this is the first report of an increased prevalence of mitochondrial gene variants in hypertensive individuals. In addition, we have identified single-nucleotide polymorphisms in flanking regions of these genes. Although replication and further assessment are necessary, the current results support our hypothesis that mtDNA may account for a portion of hypertensive cases in black Americans with ESRD.

Black or African American↗
PubMed2001

Management of the oral and maxillofacial surgery patient with thrombocytopenia.

Patients with disorders of coagulation and bleeding can be among the most challenging surgical patients to manage. Intraoperative or postoperative bleeding can contribute to life-threatening complications in even the most "benign" surgical procedures. An adequate number and function of platelets play a critical role in the coagulation pathway. A thorough understanding of platelet physiology and platelet disorders is therefore essential in the management of the thrombocytopathic oral and maxillofacial surgery patient. A careful preoperative evaluation will help the surgeon treat these patients and help prevent potentially catastrophic intraoperative or postoperative bleeding.

Adult↗
PubMed2001

Chronic musculoskeletal pain, prevalence rates, and sociodemographic associations in a Swedish population study.

OBJECTIVE: To estimate the prevalence of chronic regional and widespread musculoskeletal pain in a sample of the general adult population and study the association to age, sex, socioeconomic class, immigration, and housing area. METHODS: A cross sectional survey with a postal questionnaire to 3928 inhabitants on the west coast of Sweden. RESULTS: The age and sex adjusted prevalence of chronic regional pain (CRP) was 23.9% and chronic widespread pain (CWP) 11.4% among 2425 subjects who responded to the complete questionnaire. Odds ratio (OR) for CWP showed a systematic increasing gradient with age and was highest in the age group 59-74 yrs (OR 6.36, 95% CI 3.85-10.50) vs age group 20-34 yrs. CWP was also associated with female sex (OR 1.91, 95% CI 1.41-2.61), being an immigrant (OR 1.83, 95% CI 1.22-2.77), living in a socially compromised housing area (OR 3.05, 95% CI 1.48-6.27), and being an assistant nonmanual lower level employee (OR 1.92, 95% CI 1.09-3.38) or manual worker (OR 2.72, 95% CI 1.65-4.49) vs being an intermediate/higher nonmanual employee. OR for CRP showed a systematic increasing gradient with age and was highest in the age group 59-74 yrs (OR 2.22, 95% CI 1.62-3.05) vs age group 20-34 yrs. CRP was also associated with being a manual worker (OR 1.63, 95% CI 1.19-2.23) vs being an intermediate/higher nonmanual employee. CONCLUSION: Chronic musculoskeletal pain is common in the general population. Sociodemographic variables were overall more frequently and strongly associated with CWP than with CRP, which indicates different pathophysiology in the development or preservation of pain in the 2 groups.

Adult↗
PubMed2000

Prevalence of fibromyalgia and chronic widespread pain.

OBJECTIVE: To explore the prevalence of fibromyalgia and chronic widespread musculoskeletal pain in a general population using the criteria of the American College of Rheumatology from 1990. DESIGN: Structured interview and clinical examination, including tender-point count and pain threshold measured with a dolorimeter, of subjects with suspected chronic widespread musculoskeletal pain. SETTING: The general population in south-west Sweden 1995-1996. SUBJECTS: 303 individuals with suspected chronic widespread pain were identified in a previously defined cohort containing 2425 men and women aged 20-74 years. 202 individuals were invited and 147 agreed to participate. MAIN OUTCOME MEASURES: Tenderpoint count, pain threshold and prevalence of chronic widespread pain and fibromyalgia. RESULTS: The prevalence of fibromyalgia was estimated to 1.3% (95% CI 0.8-1.7; n = 2425) and that of all chronic widespread pain to 4.2% (95% CI 3.4-5.0; n = 2425). The mean pain threshold measured with a dolorimeter was lower in subjects with chronic widespread pain (p < 0.01) and correlated with the number of tender points (r = -0.59, p < 0.01) but could not be used to distinguish the subjects with fibromyalgia. CONCLUSION: Compared to other studies, fibromyalgia and chronic widespread musculoskeletal pain seemed to be relatively rare conditions in the south-west of Sweden.

Adult↗
PubMed1999

Evaluation of acupuncture for pain control after oral surgery: a placebo-controlled trial.

BACKGROUND: Acupuncture is increasingly being used by the general population and investigated by conventional medicine; however, studies of its effects on pain still lack adequate control procedures. OBJECTIVES: To evaluate the (1) efficacy of Chinese acupuncture in treating postoperative oral surgery pain, (2) validity of a placebo-controlled procedure, and (3) effects of psychological factors on outcomes. DESIGN: Randomized, double-blind, placebo-controlled trial. SETTING: Dental School Outpatient Clinic, University of Maryland at Baltimore. PARTICIPANTS: Thirty-nine healthy subjects, aged 18 to 40 years, assigned to treatment (n=19) and control (n=20) groups. MAIN OUTCOME MEASURES: Patients' self-reports of time until moderate pain, time until medication use, total pain relief, pain half gone, and total pain medication consumption. RESULTS: Mean pain-free postoperative time was significantly longer in the acupuncture group (172.9 minutes) than in the placebo group (93.8 minutes) (P=.01), as was time until moderate pain (P=.008). Mean number of minutes before requesting pain rescue medication was significantly longer in the treatment group (242.1 minutes) than in the placebo group (166.2 minutes) (P=.01), as was time until medication use (P=.01). Average pain medication consumption was significantly less in the treatment group (1.1 tablets) than in the placebo group (1.65 tablets) (P=.05). There were no significant between-groups differences on total-pain-relief scores or pain-half-gone scores (P>.05). Nearly half or more of all patients were uncertain of or incorrect about their group assignment. Outcomes were not associated with psychological factors in multivariate models. CONCLUSIONS: Acupuncture is superior to the placebo in preventing postoperative dental pain; noninsertion placebo procedure is valid as a control.

Acupuncture Therapy↗
PubMed1999

The prevalence of rheumatoid arthritis in Sweden.

The aim of this study was to ascertain the prevalence of rheumatoid arthritis (RA) in a Swedish general adult population. A questionnaire about chronic pain was mailed to a total of 3928 subjects who were chosen as a random sample of the population in two communities in the county of Halland. All persons answering affirmatively to questions intended to identify patients with RA were invited to a clinical examination. X-rays of hands and feet, and analyses of rheumatoid factor and C reactive protein were performed provided that the patients fulfilled two or more of the five clinical items of the 1987 ARA criteria. Furthermore, non-participants were searched for in a patient register and in medical records from the local rheumatology unit in an attempt to identify further cases. Using the modified 1987 ARA criteria for population studies the prevalence rate of RA was calculated to 0.51% (95%, CI = 0.31-0.79).

Adult↗
PubMed1998

The functional neuroanatomy of major depression: an fMRI study using an emotional activation paradigm.

An important issue regarding the neural basis of major depression is whether the functional brain changes associated with the affect disturbance seen in this syndrome are similar to those that accompany transient sadness in normal subjects. To address this question, we carried out an fMRI study using an emotional activation paradigm. Brain activity associated with passive viewing of an emotionally laden film clip aimed at inducing a transient state of sadness was contrasted with that associated with passive viewing of an emotionally neutral film clip in patients suffering from unipolar depression and in normal control subjects. Results showed that transient sadness produced significant activation in the medial and inferior prefrontal cortices, the middle temporal cortex, the cerebellum and the caudate in both depressed and normal subjects. They also revealed that passive viewing of the emotionally laden film clip produced a significantly greater activation in the left medial prefrontal cortex and in the right cingulate gyrus in depressed patients than in normal control subjects. These findings suggest that these two cortical regions might be part of a neural network implicated in the pathophysiology of major depression. Taken together, these results strongly support the view that activation paradigms represent an extremely useful and powerful way of delineating the functional anatomy of the various symptoms that characterize major depression.

Adult↗
PubMed1998

CD44 expression in sinonasal inverted papillomas and associated squamous cell carcinoma.

Increased expression of the cell adhesion molecule, CD44 standard form (CD44s), has been associated with papillary epithelial tumors, and decreased expression has been linked to tumor invasion and metastasis. Sinonasal inverted papillomas (SIPs) are the most common papillary tumors of the sinonasal tract. This study tests whether the development of squamous cell carcinoma (SCC) in situ and invasive SCC in SIP is associated with altered expression of CD44s. Seventy-six specimens of SIP from 68 patients, 2 specimens of SIP with focal SCC in situ, and 10 specimens of invasive SCC arising in SIP were studied. Automated immunohistochemistry was performed for CD44s expression on paraffin-embedded tissue sections using mouse antihuman CD44 antibody. All 76 SIPs (100%) expressed CD44 (strong membranous staining, 83%; moderate staining, 12%; weak staining, 5%). Two (100%) of 2 SIPs with SCC in situ maintained strong expression in benign and severely dysplastic foci. Six (60%) of 10 SIPs with SCC showed complete loss of CD44s expression, while 4 (40%) of 10 cases of SIP with SCC showed weak expression. Two SIPs with SCC (20%) featured weak diffuse staining of the SCC component, and 2 SIPs with SCC (20%) featured weak focal staining of the SCC component. The non-SCC SIP components of the 10 SIPs with SCC uniformly featured intact membranous CD44 staining. As in other papillary epithelial neoplasms, the typical benign SIP features diffuse membranous CD44s expression. In cases of SIP developing an invasive SCC, CD44s expression in the SCC component is frequently lost.

Adolescent↗
PubMed1997

S-100beta stimulates neurite outgrowth in the rat sciatic nerve grafted with acellular muscle transplants.

S-100beta promotes neurite extension in vitro and motoneuron survival in the chicken embryo. We demonstrate here that local administration of S-100beta stimulates the sciatic nerve regeneration into acellular muscle grafts. Normally there is a 8-10 day delay in the regeneration of axons into such grafts. Local administration of S-100beta (0.5-1.0 microg/h) significantly stimulated regeneration into the grafts. In S-100beta treated grafts, the regeneration distance was increased with a factor of about 2.3 times as compared to vehicle treated grafts. The distance of regeneration was monitored with pinch test which detects sensory axons. Regenerating axons were growing outside the necrotic muscle cells as revealed with immunohistochemistry for the neurofilament light weight polypeptide. S-100beta was demonstrated immunocytochemically in motor neurons of the rat lumbar spinal cord and in large and medium sized neurons of the dorsal root ganglia. The results suggest that S-100beta is a physiological growth factor for peripheral nerve axons.

Animals↗