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Biomedical subjects

T Strand

Publications and source records attributed to T Strand.

At least 19 recordsLinked to original sources
PubMed2004

Long-term follow-up after primary repair of the anterior cruciate ligament: clinical and radiological evaluation 15-23 years postoperatively.

INTRODUCTION: We have previously reported results after 2-5 and 5-10 years follow-up of repair of acute anterior cruciate ligament (ACL) ruptures by suturing. Reports of results after more than 10 years are rare. MATERIALS AND METHODS: A total of 140 patients were operated on in the period 1975-1983 (age range 13-71 years, median 28 years) by the modified Palmer technique. Only 2 meniscus resections and 4 meniscectomies were performed at the primary operation; while 28 menisci were sutured. At follow-up,12 patients were dead. Eighteen patients (13%) underwent repeat operations for secondary instability. Of the remaining 110 patients, 81 appeared for follow-up. RESULTS: Only 6 secondary meniscus resections were performed, all in the group of 18 patients operated on again for instability. No secondary meniscus surgery was performed on the 81 patients who appeared for follow-up. The median Lysholm score was 88, and 58 of the 81 patients (71%) classified their total knee function as good or excellent. By KT-1000 testing, 33 (41%) patients had less than 3 mm anterior instability, 29 (36%) had 3-5 mm instability, and 17 (21%) had more than 5 mm. With 18 patients from the total of 128 living patients re-operated for instability, we estimate the rate of total failure of stability as 27%. Radiological osteoarthritis grade C was present in 8 operated and 2 control knees, while only 1 operated knee revealed osteoarthritis grade D. Thirty-four operated and 20 control knees had grade B. Osteoarthritis was correlated to more advanced age at injury, while correlation to function could not be proven. Radiographs were obtained of 61 patients at follow-up. CONCLUSIONS: Some 50% of patients had stable or slightly unstable knees, and 40% good or excellent function according to the Lysholm score. Re-operation for instability was more frequent in younger patients, while ostearthritis was more frequent in older patients. The rate of meniscus resection or extirpation was low. Open repair by suture is no longer recommended. Further research is indicated on the possible use of refixation of the ruptured ACL by arthroscopy.

Adolescent↗
PubMed2004

The influence of geological factors on indoor radon concentrations in Norway.

Indoor radon levels in 1618 Norwegian dwellings located in different geological settings are compared with geological information. The results show a significant correlation between indoor radon levels and geological factors. Radium content and permeability of the building ground have been found to be useful indicators of indoor radon concentrations. Based on easily accessible geological data, an assessment of the radon potential of an area can be given. Areas of high radon risk in Norway include: (a) exposed bedrock with elevated levels of radium; and (b) highly permeable unconsolidated sediments derived from all rock types and moderately permeable sediments derived from rock types rich in radium. A comparison of indoor radon with house construction characteristics and ventilation habits suggests that radon concentrations in Norwegian dwellings are also influenced by ventilation system, aeration habits and floor level of the room where the measurements were carried out. The significant correlation between indoor radon levels and geological factors observed in the present investigation indicates that it is possible to outline areas of high radon risk in Norway based on geological information.

Air Pollution, Indoor↗
PubMed2004

Indoor gamma radiation and radon concentrations in a Norwegian carbonatite area.

Results of indoor gamma radiation and radon measurements in 95 wooden dwellings located in a Norwegian thorium-rich carbonatite area using thermoluminescent dosemeters and CR-39 alpha track detectors, respectively, are reported together with a thorough analysis of the indoor data with regard to geological factors. Slightly enhanced radium levels and thorium concentrations of several thousands Bq kg(-1) in the carbonatites were found to cause elevated indoor radon-222 levels and the highest indoor gamma dose rates ever reported from wooden houses in Norway. An arithmetic mean indoor gamma dose rate of 200 nGy h(-1) and a maximum of 620 nGy h(-1) were obtained for the group of dwellings located directly on the most thorium-rich bedrock.

Air Pollutants, Radioactive↗
PubMed2004

Rapid response car as a supplement to the helicopter in a physician-based HEMS system.

BACKGROUND: The purpose of this study was to describe the use of a rapid response car (RRC) as a supplement to the ambulance helicopter in a mixed urban/rural region in Norway. METHODS: Data from all the requested missions were collected from standard flight records. Operational factors, patient characteristics, primary diagnosis, treatment and modes of transport were registered and analyzed retrospectively. RESULTS: In 1999-2001, a total of 4777 requests were included in the study, resulting in the initiation of 3172 helicopter and 752 RRC missions. In the RRC missions, 224 patients received advanced medical treatment that would otherwise not have been provided. For 181 patients, the availability of the RRC was crucial for receiving the treatment of the helicopter emergency medical services (HEMS). The cost of equipping the base with the RRC increased the annual budget by less than one percent. CONCLUSION: The RRC was essential for solving missions in periods of non-flying conditions. The RRC increased the availability of the advanced prehospital life support offered by the HEMS in this region. Taking the modest increase in cost into consideration, it seems reasonable that this HEMS, covering mixed urban and rural areas, is equipped with such a vehicle.

Air Ambulances↗
PubMed2001

Micronutrient deficiency in children.

Malnutrition increases morbidity and mortality and affects physical growth and development, some of these effects resulting from specific micronutrient deficiencies. While public health efforts must be targeted to improve dietary intakes in children through breast feeding and appropriate complementary feeding, there is a need for additional measures to increase the intake of certain micronutrients. Food-based approaches are regarded as the long-term strategy for improving nutrition, but for certain micronutrients, supplementation, be it to the general population or to high risk groups or as an adjunct to treatment must also be considered. Our understanding of the prevalence and consequences of iron, vitamin A and iodine deficiency in children and pregnant women has advanced considerably while there is still a need to generate more knowledge pertaining to many other micronutrients, including zinc, selenium and many of the B-vitamins. For iron and vitamin A, the challenge is to improve the delivery to target populations. For disease prevention and growth promotion, the need to deliver safe but effective amounts of micronutrients such as zinc to children and women of fertile age can be determined only after data on deficiency prevalence becomes available and the studies on mortality reduction following supplementation are completed. Individual or multiple micronutrients must be used as an adjunct to treatment of common infectious diseases and malnutrition only if the gains are substantial and the safety window sufficiently wide. The available data for zinc are promising with regard to the prevention of diarrhea and pneumonia. It should be emphasized that there must be no displacement of important treatment such as ORS in acute diarrhea by adjunct therapy such as zinc. Credible policy making requires description of not only the clinical effects but also the underlying biological mechanisms. As findings of experimental studies are not always feasible to extrapolate to humans, the biology of deficiency as well as excess of micronutrients in humans must continue to be investigated with vigour.

Breeding↗
PubMed1998

The chemistry of Norwegian groundwaters: I. The distribution of radon, major and minor elements in 1604 crystalline bedrock groundwaters.

A quality-controlled hydrogeochemical dataset of 1604 groundwater samples from Norwegian crystalline bedrock aquifers has been obtained and subject to analyses of radon (scintillation counting), major and minor elements (ion chromatography and ICP-AES), pH and alkalinity. Cumulative probability curves may be constructed to assess the risk of given parameters violating drinking water norms. Parameters such as radon and fluoride show clear lithological correlation, occurring at high concentrations in granites and low concentrations in anorthosites. Other parameters exhibit a lower degree of correlation with aquifer geochemistry (e.g. pH, major ions) and are likely to be governed by more universal thermodynamic equilibria (the calcium carbonate system) and kinetic factors. On a national basis 13.9% of the bedrock groundwaters exceed the recommended action level for radon, while 16.1% exceed the drinking water norm for fluoride. Considering pH, sodium, radon and fluoride together, 29.9% of all wells violate drinking water maximum concentrations for one or more of these parameters.

Calcium↗
PubMed1998

The chemistry of Norwegian groundwaters: II. The chemistry of 72 groundwaters from Quaternary sedimentary aquifers.

Seventy-two samples of groundwater derived from Norwegian Quaternary (largely glaciofluvial or glacial) aquifers were analysed for a wide range of major and minor hydrochemical parameters. The waters exhibit a relatively uncomplex evolution from Na-Cl dominated, immature waters (which reflect marine salts in precipitation) to Ca-HCO3 dominated waters via calcite dissolution. The median pH of these waters is 7.37, in contrast to similar waters from crystalline bedrock aquifers with a median pH of 8.07. The water samples provide little evidence of significant acidification or sulphatisation of groundwaters by 'acid rain'. In fact, a positive correlation emerges between non-marine sulphate and alkalinity/pH, suggesting dominantly lithological sources for non-marine sulphate. No groundwaters from Quaternary deposits exceed maximum recommended concentrations for Rn, F- and Na, while 10% fall outside the required pH range. This again contrasts with bedrock aquifers where 30% of waters are non-compliant with respect to one or more of these parameters.

Acid Rain↗
PubMed1998

Lateral ligament injuries of the knee.

Between 1982 and 1994 28 patients were treated for acute lateral knee ligament injuries; 25 patients, with a median age of 25.5 (range 16-75) years at injury, appeared for follow-up. Seven patients had isolated injury of the lateral collateral ligament/capsular structures, the remaining 19 patients had concomitant ligament injuries in the knee. Eight patients were treated conservatively, 1 with plaster immobilization and 7 with early mobilization. Eighteen patients underwent surgery, 17 of these within 3 weeks of injury. Repair/reconstruction of the cruciate ligaments was done at the same time as the lateral collateral ligament repair in 10 patients. At follow-up after a median of 7.5 years (range 6 months to 13 years), 11 had no varus instability, 7 had 1+, 5 had 2+, and 2 patients had 3+ varus instability. All patients with a final result of 2+ or 3+ had combined ligament injuries. The surgically treated lateral collateral ligament injuries all had a primary instability of 2+ or more. These patients showed an improvement in varus instability from a mean of 2.83+ preoperatively to a mean of 1.17+ postoperatively. Two-thirds of the surgically treated patients were stable or had a 1+ instability at follow-up. One conservatively treated patient with a 2+ varus instability and 1 with 1+ showed no improvement. Five conservatively treated patients with initial varus instability of 1+ were stable at follow-up. One patient with a 1+ varus instability had anterior cruciate ligament (ACL) rupture. He had a primary ACL reconstruction without lateral repair. He had no varus instability at follow-up. Our study supports the notion that operation performed at an early stage in fresh injuries with a varus instability of 2+ or more gives improved stability as a final result. Conservative treatment may not be expected to give an improved stability, but is sufficient in mild varus instability (1+) without additional cruciate ligament injuries.

Adolescent↗
PubMed1997

[Ground water and health. Reflections based on analysis of water specimens from Hordaland and Vestfold].

Basically, Norway has an ample supply of water. The quality of Norwegian drinking water, however, is threatened, not the least because of pollution of surface water reservoirs. Ground water is better protected against pollution, and sub-surface water sources are being exploited more than before. At present, less than 15% of the Norwegian population uses ground water for household purposes, but the percentage is increasing rapidly Ground water is (normally) clean and has a good taste. A large number of elements can be traced in ground water; some of them in concentrations of significance for human health. The present paper reports elemental analyses of 150 water samples from ground water reservoirs in rock, collected in Vestfold (Eastern Norway) and Hordaland (Western Norway). Sixty-four elements were assessed using modern equipment such as ICP-MS. In most cases the chemical composition of the water was well within the limits set for good quality drinking water. For some of the elements one or more of the results exceeded the "highest acceptable concentrations" as defined by the Norwegian health authorities. This was the case for Al, As, Ba, Ca, Cd, F, Fe, Hg, K, Mg, Mn, Na, P, Pb, Rn and Zn. No drinking water standards have been established for Be, Mo, Th and U, which are of clear significance to the health. More research is needed to assess the relationship between drinking water chemistry and human health. The authors call for a systematic analysis of all Norwegian ground water wells, and emphasise the need for regular quality control, even of small, private water supplies.

Humans↗
PubMed1997

Registration of cruciate ligament injuries in Norwegian top level team handball. A prospective study covering two seasons.

All cruciate ligament injuries in the three upper divisions for men and women (3392 players) in Norwegian team handball in the 1989-90 and 1990-91 seasons were registered. A questionnaire was mailed to all injured players. Ninety-three cruciate ligament injuries were registered; 87 in the anterior cruciate ligament (ACL), and six in the posterior cruciate ligament (PCL). Among women, 1.8% were injured compared with 1.0% of the men. In the first division, the risk of being injured was considerably higher: 4.5% of the players had a cruciate ligament injury. There were 0.97 cruciate ligament injuries per 100 playing hours in the three divisions taken together. Seventy-five per cent of the injuries occurred during games. Ninety-five per cent involved no contact between players. Activities in which the friction between shoe and floor was significant caused 55% of the injuries. Injuries caused by running into another player contributed to only 5% of the injuries. No significant differences were observed in injury incidence during matches between different types of floors (parquet, Pulastic and other synthetic surfaces.)

Adolescent↗
PubMed1997

Undiagnosed anterior cruciate ligament rupture. A common problem with poor prognosis.

BACKGROUND AND AIMS: Our knowledge on how often tears of the anterior cruciate ligament (ACL) initially remain undetected and the outcome of the resulting non-operative regimen is still incomplete. To investigate these issues, we conducted a follow-up study in young individuals that 4 to 5 years earlier had sustained a knee injury during a sports event that had been diagnosed as a first-degree sprain. MATERIAL AND METHODS: The patients (n = 54) were grouped according to present symptoms (pain or instability): A, no symptoms (n = 27), B, moderate symptoms (n = 16) and C, severe symptoms (n = 11). Eight group A patients, 11 group B patients and 8 group C patients participated in the follow-up study. Symptoms and level of activity were evaluated and clinical examination of the knee and KT-1000 instrumented measurement of anterior knee laxity were performed. RESULTS AND CONCLUSIONS: Increased anterior laxity was demonstrated in 7 patients (1 in group B and 6 in group C). In the same period these injuries occurred, acute ACL rupture was diagnosed in our region in 16 patients. The proportion of overlooked ACL ruptures to injuries interpreted as a first-degree sprain and to total number of ACL ruptures sustained during the same period was at least 7 out of 54 (13%) and at least 7 out of 23 (30%), respectively. The subjective symptom score was higher and Lysholm's and Tegner's scores lower in the patients with increased anterior laxity compared to the patients with no increased anterior laxity. We conclude that ACL rupture may be overlooked in a rather high proportion and that the 4-5 years' result in such injuries is poorer than in those without increased anterior laxity.

Adolescent↗
PubMed1996

Radon, fluoride and 62 elements as determined by ICP-MS in 145 Norwegian hard rock groundwater samples.

Hard rock groundwater (145) samples collected from private drinking water wells in the environs of Oslo and Bergen were analysed for their radon and fluoride contents. A further 62 elements were determined by inductively coupled plasma mass spectrometry (ICP-MS). For 59 elements, more than 50% of all concentration values were above the detection limit. Characteristic differences between the Oslo- and Bergen-dataset can be shown to be related to host rock lithology. Variation in element contents generally spans 2-6 orders of magnitude. Concentrations of several elements (e.g. Ba, F, Fe, Mn, Na, Rn) exceed current drinking water action levels in a significant number of cases. High levels of other parameters such as Be, Mo, Th and U, which could have an impact on health, were observed. There are no Norwegian action levels currently defined for these elements. The economic and toxicological impacts of these findings require urgent assessment.

Elements↗
PubMed1996

[Out-of-hospital buffer therapy in heart arrest].

The effects of infusing a buffer solution on resuscitability and outcome were tested in patients during out-of-hospital cardiac arrest. 502 adults with ventricular fibrillation or asystole with failure of first attempt at defibrillation were entered into a prospective, randomized, double-blind, controlled trial where one group received buffer and the other group placebo (saline). 87 of 245 (36%) patients who received a buffer were admitted to hospital and 24 (10%) were discharged alive, as against 92 of 257 (36%) admitted to hospital and 35 (14%) discharged alive for those who received placebo. Only 16 of the 502 patients had arterial alkalosis on arrival at hospital and no patient had a positive base excess. Patients resuscitated after out-of-hospital cardiac arrest had metabolic acidosis but buffer therapy did not improve outcome.

Adult↗
PubMed1996

A prospective, randomized study of three operations for acute rupture of the anterior cruciate ligament. Five-year follow-up of one hundred and thirty-one patients.

A five-year, prospective, randomized follow-up study was done to compare three methods for repair of a rupture of the anterior cruciate ligament of the knee; acute primary repair (Group 1), acute repair with a synthetic ligament-augmentation device (Group 2), and acute repair augmented with an autologous bone-patellar ligament-bone graft (Group 3). One hundred and fifty patients who had an acute rupture of the anterior cruciate ligament were randomized to one of the three repair groups, with fifty patients in each group. The patients were between sixteen and fifty years old (mean, twenty-nine years old). All patients had the operation within ten days after the injury. The rehabilitation protocol was identical for each group. The patients were evaluated prospectively at one, two, and five years with use of the Tegner scoring system for level of activity and the scoring system of Lysholm and Gillquist for function, and the stability of the knee was assessed with clinical examination and with use of the KT-1000 arthrometer. One hundred and thirty-one patients completed the study and ten other patients were known to have had a failure of the procedure, a 94 percent rate of follow-up. All three groups had a lower level of activity at the five-year follow-up evaluation than they had had before the injury. The patients who had had augmentation with a patellar-ligament graft had a significantly higher mean level of activity at two years than those who had had non-augmented repair with (p = 0.002) and those who had had repair with a synthetic ligament-augmentation device (p = 0.01). They also had a significantly higher mean level of function at two years than those who had had non-augmented repair (p = 0.0001) and those who had had repair with a synthetic ligament-augmentation device (p = 0.03) and a significant higher mean level of function at five years than those who had had non-augmented repair (p = 0.004). The ability to attain full extension improved significantly in all three groups during the five-year follow-up period; the highest gains occurred in the group that had had augmentation with a patellar-ligament graft. Rotatory and anterior instability progressively increased during the follow-up period for all three groups. At one, two, and five years, the knees that had had repair with a patellar-ligament graft were significantly more stable than those that had had non-augmented repair and those that had had repair with a ligament-augmentation device (p < 0.0001 to p = 0.03). The findings of this study reinforce the conclusions of our two-year follow-up report that a non-augmented primary repair should not be performed, a repair with a ligament-augmentation device has an unacceptably high rate of failure (more than one-third of the patients), and a repair that is augmented with the patellar ligament has the best outcome.

Adolescent↗
PubMed1995

Buffer therapy during out-of-hospital cardiopulmonary resuscitation.

The effects of infusing a buffer solution on resuscitability and outcome was tested in patients during out-of-hospital cardiac arrest. A number (502) of adults with asystole or ventricular fibrillation with failure of first defibrillation attempt were entered into a prospective, randomized, double-blind, controlled trial. Of these, 245 patients received 250 ml of sodium bicarbonate-trometamol- phosphate mixture with buffering capacity 500 mmol/l and 257 patients received 250 ml 0.9% saline. Except for the investigational infusion, all patients were resuscitated according to international guidelines. Eighty-seven patients (36%) receiving buffer were admitted to hospital ICU and 24 (10%) were discharged from hospital alive, vs. 92 (36%) and 35 (14%) receiving saline (95% confidence interval (CI) for difference between groups: -6%-6% for rate of admission and -1%-9% for rate of discharge). Using a logistic regression analysis, ventricular fibrillation as initial rhythm (odds ratio 8.06, CI 3.70-17.56) improved the outcome, whereas buffer therapy had no effect (odds ratio 0.77, CI 0.43-1.41). Mean base excess at hospital admission was -9 after Tribonat vs. -11 after saline (P = 0.04, CI for difference 0.2-3.8). Only 16 of the 502 patients had arterial alkalosis on arrival in the hospital and no patient had a positive base excess. Patients resuscitated after out-of-hospital cardiac arrest had metabolic acidosis, but buffer therapy did not improve the outcome.

Acidosis↗
PubMed1995

Clinical tests versus KT-1000 instrumented laxity test in acute anterior cruciate ligament tears.

Forty-two patients referred to the outpatient clinic of Hagavik Orthopaedic Hospital within 3 weeks after an acute knee injury was found by arthroscopy to have a partial or total tear of the anterior cruciate ligament (ACL). In these patients, the results of clinical tests and instrumented laxity tests without anesthesia prior to the arthroscopy were analyzed. The Lachman test and the maximum anterior pull (150-200 N) KT-1000 instrumented test revealed abnormal laxity in 33 and 37 of 42 cases, respectively. Both tests revealed abnormal laxity more often than the KT-1000 test using 67 N (10/42) and the maximum anterior pull KT-1000 instrumented test also revealed abnormal laxity more often than the KT-1000 test using 89 N (25/42). By logistic regression analysis, the maximum anterior pull KT-1000 instrumented test was associated with rupture of the ACL (partial or total rupture). The results show that adequate anterior pull has to be used to overcome muscle tension to reveal abnormal laxity in acute ACL tears using the KT-1000 arthrometer.

Adolescent↗
PubMed1995

A call for specific codes for diabetes foot and eye care.

In this report, we propose new International Classification of Diseases (ICD) codes that could be incorporated into computer-based patient records or administrative data to monitor and improve diabetes care. Neither the ICD, 9th Revision, nor its imminent replacement, the ICD, 10th Revision, has specific codes for foot examinations and funduscopic examinations in the asymptomatic person, high-risk diabetic foot status, or clinically significant macular edema. Adoption of official codes for these procedures and conditions implemented in conjunction with computerized databases could be used for surveillance, program planning, and quality of care assessment. Computerized medical records could use the codes to monitor care and issue reminders to patients and providers. Payors could offer reimbursement incentives to encourage compliance with standard recommendations. These codes for care procedures could be linked to outcomes, such as amputations and blindness, to improve our understanding of the etiology of blindness and the relationship between process and outcome. The uniform adoption of these codes would facilitate comparison between health care systems, geographic regions, and nations. The diabetes community should encourage the National Center for Health Statistics to adopt new codes that could be used to monitor diabetes preventive care practices.

Adult↗