Biomedical subjects
Publications and source records attributed to S M Almdahl.
This article presents a study of the use of tobacco and alcohol among young servicemen in Northern Norway during the last nine months of their military service. The study shows a clear tendency towards increased smoking, while alcohol consumption is less frequent than during the period before entering military service.
The mitochondrial isoenzyme of aspartate aminotransferase showed only slight increases in serum of twenty-seven patients after uncomplicated coronary bypass surgery, which contrasted the rapid and substantial increases in creatine kinase MB. In seven patients suffering perioperative infarction or serious complications, substantial increases in mitochondrial aspartate aminotransferase were detected and the elevations in creatine kinase MB were prolonged. Mitochondrial aspartate aminotransferase may appear as a specific marker of myocardial necrosis following coronary bypass surgery. The elevations of creatine kinase and creatine kinase MB were detected as early as 5 minutes after onset of coronary reperfusion and slightly higher activities were measured in coronary sinus blood than in systemic blood sampled simultaneously. Increases in mitochondrial aspartate aminotransferase, however, could first be measured 8 hours after reperfusion.
We have used the right gastroepiploic artery as a viable jump graft to the distal right coronary artery in two patients. The first patient was a 37 year-old man with recurrent angina after coronary bypass surgery with three vein grafts eight years previously. The second patient was a man aged 45 with angina in New York Heart Association Class III to IV. In both cases coronary angiography revealed severe triple vessel disease with multiple proximal and distal occlusions or stenosis. Both internal mammary arteries were also used in the two patients to revascularize the LAD and circumflex systems. Thus, a complete revascularization was achieved by use of only viable arteries as conduits. Both patients recovered well and were free from angina. At present only the first patient has had a postoperative angiogram, which showed good patency of the gastroepiploic artery jump graft. If the long-term patency of this type of graft is similar to that of the internal mammary arteries, it is another suitable arterial conduit for revascularization of the ischemic myocardium.
Enterobacter cloacae was isolated from 69 patients hospitalized at the University Hospital of Tromsø, Norway, during a period of 18 months. The total lethality was 11.6% (8/69) and death occurred most often in patients with a serious underlying condition. Death due to septicaemia occurred in 4/10 patients. Multiple beta-lactam resistant strains were present in 15 patients and were associated with septicaemiae (7/10, p less than 0.0005). Cephalosporin treatment had been given to every third patient (24/69), and nearly half of them (10/24) were infected by multiple beta-lactam resistant E cloacae. E cloacae occurred mainly as a nosocomial infection, since more than 70% of all patients infected had been treated by an invasive procedure prior to isolation of the bacterium. A high number of E cloacae strains were from operation wounds, especially among patients at the Department of Surgery (22/30). At this Department, the total number of E cloacae, and especially the number of multiresistant strains, was markedly reduced during restricted use of cefalosporins.
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During a 7-year period, 237 patients were treated surgically at Tromsø Hospital for varices of the great saphenous vein. At follow-up (mean 7.5 years) the overall results were excellent in 30%, good in 47%, and poor in 21% of the patients. The recurrence rate of varicose veins was 47%. However, 50% of these patients had no symptoms or only minor symptoms, from the recurrence. 37 patients noticed the occurrence of troublesome varicose veins within one year after operation. At clinical reexamination it was found that in 32 of these patients the surgery had been inadequate. This probably explains the rapid recurrence.
In a prospective study, 69 young adults, range 19-28 years, were given spinal anesthesia. Three patients developed postspinal puncture headache and three patients experienced transient backache. No other complications were observed. The results indicate that spinal anesthesia may be used even in young adults. This seems to contrast with the practice in most other Norwegian hospitals, where spinal anesthesia is given mainly to patients older than 40 years of age, based on the notion that the frequency of postspinal puncture headache is unproportionally high in younger patients.
We describe five patients with serious nosocomial infection caused by resistant Enterobacter cloacae. Four of the patients underwent cardiovascular operations and were infected with an identical, multiple beta-lactam resistant E cloacae strain. The fifth patient was admitted with several wounds and skin-ulcers containing both resistant and sensitive E cloacae of other types. The resistant strain caused septicemia in four patients; three developed multiorgan failure and one died. The most probable causes of these infections were an abundant and constant reservoir of E cloacae in a sink at the operating unit, periodical breakdown of barriere routines, and heavy use of cephalosporins.
In the period January 1, 1975, through December 31, 1986, 28 patients were treated for hand injuries caused by small home rotary snowcutters. These injuries were characterized by extensive lacerations and contusions, particularly on the dorsal side of the hand and the fingers, with concomitant extensor tendon ruptures, comminuted and complicated fractures, and traumatic amputations of fingers of the dominant hand. The index and middle finger were nearly always injured; the thumb was usually totally spared. The frequency of postoperative complications was low after delayed primary surgical treatment. In this series the mean permanent medical disablement was found to be 12%, ranging from 0 to 50%. The present observations, when made available, alarmed national authorities. In turn, manufacturers were required to equip rotary snowcutters with motorquenchers. This device will probably effectively prevent these injuries in the future.
During the period March 1987-May 1988, postoperative infection or colonization with Enterobacter cloacae occurred in 9/379 (2.4%) patients who underwent cardiovascular surgery. Five of the patients were infected with multiply beta-lactam resistant E. cloacae, of whom 4 had been infected with an identical, resistant strain during intervals of months. This strain was also found in the environmental flora of the cardiovascular operating suite and in a sink reservoir in the surgery department. All 4 patients with the identical resistant strain had serious complications during the postoperative period with symptoms of septicaemia in 3, multiorgan failure and shock in 2, and mediastinitis in 3. The single resistant strain of a different serotype was also associated with severe postoperative complications. The 4 sensitive strains were all different serotypes. None caused septicaemia, one was associated with mediastinitis, another with an uncomplicated sternum infection, and 2 were from sputum. In the 3 latter patients with sensitive strains and few postoperative complications, cephalosporins had not been used during the pre- or postoperative period.
During 1977 and 1978, we operated on 34 patients with chronic anterior tibial compartment syndrome. Surgery consisted of subcutaneous fasciotomy of the anterior crural compartment under local anesthesia. Twenty-three patients were operated on bilaterally. The mean follow-up was 10 years. One patient was lost to follow-up, leaving a total of 56 legs for assessment. The long-term result was excellent in 31 legs, good in 10, fair in 11, and poor in 4. There was one recurrence. This was relieved by refasciotomy.
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Rats were subjected to laparotomy, to pancreatectomy, to gastroenterectomy (control groups), or to these procedures plus a septic challenge by instillation of 0.1 ml feces intraperitoneally (experimental groups). In the laparotomized controls plasma somatostatin values were significantly higher in samples from the portal vein than from the upper inferior caval vein. After both pancreatectomy and gastroenterectomy a significant fall in plasma somatostatin values was observed, and there was no significant difference between samples taken from the portal vein and the systemic circulation. An intraperitoneal septic challenge elicited a significant rise in portal plasma somatostatin in laparotomized rats, whereas this increase did not occur in pancreatectomized and gastroenterectomized animals, supporting the notion that plasma somatostatin originates from the pancreas and/or the gastrointestinal tract during septic peritonitis. No differences were detected in plasma vasoactive intestinal polypeptide (VIP) values in animals from the three control groups. However, both in laparotomized and in pancreatectomized septic animals a significant rise in plasma VIP was demonstrated in samples from the portal vein. By contrast, no such increase was observed in gastroenterectomized septic rats. Thus, the gastrointestinal tract seems to be the major source of circulating VIP during fecal peritonitis in the rat.
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