Biomedical subjects
Publications and source records attributed to S Landin.
When a hernia becomes symptomatic with pain, obstruction, or mechanical distortion, need for a repair is likely. In this short note are new aspects on the Onlay mesh repair technique of parastomal hernias presented. The satisfactory results achieved in 5 patients are reported. One recurrence required a further successful repair.
OBJECTIVE: To compare outcome of unilateral and bilateral laparoscopic hernia repair. DESIGN: Prospective consecutive trial. SETTING: University hospital, Sweden. SUBJECTS: 380 patients who had unilateral hernias repaired laparoscopically and 64 patients who had bilateral hernias repaired. The median (range) age in the two groups was 56 (21-86) and 61 (30-85) years, respectively and the median (range) follow-up was 42 (24-58) months. MAIN OUTCOME MEASURES: Operating time, hospital stay, complications, and time to recovery. RESULTS: The median (range) operating time was 70 (25-240) minutes in the unilateral and in the bilateral group 113 (55-330) minutes. The complication rate, recurrence rate, and time to full recovery did not differ between the groups. CONCLUSION: The laparoscopic approach seems to be a good option for patients with bilateral inguinal hernias.
16 patients representing 7 different pedigrees exhibited an unusual, adult onset limb-girdle myopathy with typical clinical hallmarks. In a majority of cases there was evidence of an autosomal dominant inheritance. A prominent early finding in all cases was respiratory muscle weakness, and in many of these an acute respiratory incapacity was the reason for the first neurological examination. Neck flexor and sometimes foot extensor weakness were other early symptoms. The clinical picture seems to be at variance with that of the more well known hereditary myopathies. Electrophysiological analysis confirmed a myopathy and serum muscle enzyme concentrations were normal or slightly elevated. Muscle biopsy findings revealed myofibrillar changes which, at the light microscopy level, included plaques that stained strongly with rhodamine-conjugated phalloidin, a specific marker for F-actin. At the ultrastructural level, these plaques were observed to be composed of moderately dense, thin filaments and were related to splitting of Z-discs or formed extensions from Z-discs. We believe that the muscle biopsy changes revealed by cytochemical and ultrastructural observations indicate defective myofibrillogenesis, and the possibility of defective actin polymerization is discussed. A conclusive answer requires further immunocytochemical and immunoelectrophoretic studies and possibly the application of molecular genetics.
Abnormally low proportions of total T lymphocytes were found in peripheral blood lymphocytes (PBL) of patients with multiple sclerosis (MS) accompanied by high proportions of T lymphocytes with Fc receptors (FcR) for IgG (T gamma cells). Seventy-five percent of the MS patients had greater than 40% T gamma in the T lymphocyte-enriched population. In 6 out of 16 cases, T mu were also elevated. This elevation, however, did not seem to correlated with disease stage. By mixed rosetting and direct observation with an indirect immunofluorescence test, 30 to 50% of the T gamma cells in MS PBL were also shown to bear FcR for IgM. This population bearing FcR for IgG and IgM, designated T gamma mu, was usually found to be 10% or less of the T gamma population in normal controls. The significance of this T gamma mu population for the MS disease process requires further evaluation.
Proportions of T cells and T cell subsets, as identified by their Fc receptors (FcR) for IgM and IgG (Tmu and T gamma), were determined in the peripheral blood lymphocyte (PBL) and cerebrospinal fluid (CSF) lymphocyte populations in patients with multiple sclerosis (MS). On average, MS patients had 79% total T cells (62% of which were T gamma, 66% Tmu) in CSF lymphocytes compared to 66% total T cells (30% T gamma, 63% Tmu) in PBL. Normal age- and sex-matched controls PBL had 74% total T cells (20% T gamma, 54% Tmu). By direct observation using an indirect immunofluorescence assay, 41% of the CSF T gamma cells in MS patients bore receptors for IgM; these cells were designated T gamma mu and, according to the double-marker analysis, did not seem to correlate with disease stage. In MS PBL, 20% of T gamma cells were T gamma mu compared to 9% in the control PBL T gamma population. Thus, MS patients had a higher proportion of total T cells, T gamma cells and T gamma mu cells in their CSF than in their peripheral blood and than those populations found in normal control blood. The significance of this T gamma mu population for the continuing disease state in MS is discussed.
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Ultrastructural studies of muscle biopsies from the vastus lateralis of the quadriceps in seven patients with Parkinson's disease and six patients with upper motor lesions are presented. All patients showed varying degrees of mitochondrial changes. Loss of outer membranes or abnormal inner membranes were observed alone or in combination. A reduced number of mitochondria was also noted in some cases. A disorder of filaments was seen. It is assumed that the mitochondrial changes are connected with the altered oxidative capacity previously observed in these patients.
In recent muscle metabolic studies, patients with moderate upper motor neuron lesions showed marked difficulty in performing an equal submaximal work load (bilaterally) in two-legged exercise. For a better evaluation of these patients, studies were performed on each leg separately. Six patients with Parkinson's disease and six with moderate hemiparesis were studied. During one-legged submaximal and maximal exercise heart rate, oxygen uptake, and blood lactate were determined. Maximal voluntary contraction in knee and ankle flexion and extension for each leg was measured. Succinate dehydrogenase (SDH) activity in the thigh muscles was determined. During submaximal exercise, oxygen uptake, heart rate and blood lactate increased more in the paretic leg of hemiparetic patients and in the more affected leg of the Parkinson patients. In hemiparetic patients maximal voluntary contraction of flexors and extensors of the knee was significantly reduced in the paretic leg but was reduced even in the nonparetic knee flexors. SDH activity was very low in both legs in all patients and lowest in the paretic and more affected leg, respectively. It is concluded that (a) the general muscle inactivity per se, secondary to the neurological disorder, may lead to a reduced work capacity; (b) the increased heart rate and blood lactate level seem to be correlated to the relative exercise level of each leg; and (c) in patients with impaired muscle function of one or both legs, evaluation of each leg separately with regard to work capacity and muscle metabolism is of value.
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