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Sökning: hsv:(MEDICIN OCH HÄLSOVETENSKAP) hsv:(Klinisk medicin) > (1990-1999) > (1997)

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31.
  • Holst, Göran, et al. (författare)
  • The relationship of vocally disruptive behavior and previous personality in severely demented institutionalized patients.
  • 1997
  • Ingår i: Archives of Psychiatric Nursing. - 1532-8228. ; 11:3, s. 147-154
  • Tidskriftsartikel (refereegranskat)abstract
    • The aim of this study was to explore the previous personalities of patients, their behavior during the course of the disease, and the relationship between the previous personality and vocally disruptive behavior of severely demented patients. Twenty-one severely demented patients identified as vocally disruptive and 19 severely demented control subjects who were matched for gender and ward were studied. A family member or close relative who knew the patient very well described the patient's personal characteristics from what they judged to be the “best” period in the patient's life and responded, on behalf of the patient, to the 57 items in a modified version of the Eysenck Personality Inventory. The results of this study can be interpreted to indicate that a previous personality described as introverted, rigid, and with a tendency to control emotions, as remembered retrospectively by a close family member, may correlate to current disruptive behavior. Despite the limitations of this study, the findings indicated that a patient's previous personality characteristics need to be taken into consideration because they may partially explain vocal activity and are therefore important for the provision of nursing care. Further research has to be performed to highlight the impact of previous personality characteristics on various kinds of behavior during the course of the disease.
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32.
  • Ingemansson, Richard, et al. (författare)
  • Addition of calcium to Euro-Collins solution is essential for 24-hour preservation of the vasculature
  • 1997
  • Ingår i: Annals of Thoracic Surgery. - 1552-6259. ; 63:2, s. 408-413
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Genuine Euro-Collins solution is calcium free. The aim of this study was to investigate whether the addition of calcium would improve its capacity to preserve the vasculature. METHODS: The infrarenal aorta of Sprague-Dawley rats was investigated in organ baths: as fresh controls, after 24 hours of cold (4 degrees C) storage in Euro-Collins solution, or in Euro-Collins solution with the addition of calcium in amounts ranging from 0.05 to 1.5 mmol/L. The thromboxane analogue U-46619 was used to investigate contractility. Endothelium-dependent relaxation was tested by cumulative addition of acetylcholine. Papaverine was used to elicit endothelium-independent relaxation. Investigation by transmission electron microscopy was also performed. RESULTS: Storage of rat aorta for 24 hours in genuine Euro-Collins solution almost abolished smooth muscle function, and severe edema was found in the endothelial cells. However, if calcium was added, the rat aorta could be stored for 24 hours without affecting smooth muscle function, and endothelium-dependent relaxation was only slightly reduced. Furthermore, only slight edema could be demonstrated in the endothelial cells. CONCLUSIONS: If calcium is added to Euro-Collins solution in amounts ranging from 0.4 to 1.5 mmol/L, it allows good preservation of rat aorta for 24 hours. Without calcium, this solution destroys both the function and morphology of the vessels.
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33.
  • Ingemansson, Richard, et al. (författare)
  • Effect of flush-perfusion on vascular endothelial and smooth muscle function
  • 1997
  • Ingår i: Annals of Thoracic Surgery. - 1552-6259. ; 64:4, s. 1075-1081
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The aim of this study was to investigate how much perfusion pressure an artery can tolerate without significant loss of endothelium-dependent relaxation (EDR) and vascular contractility. METHODS: The abdominal aortas of 396 Sprague-Dawley rats were used. One hundred twenty aortas were flush-perfused for 1 or 5 minutes with cold St. Thomas' Hospital cardioplegic (STHC) solution or with the same solution but modified by the addition of 3.5% dextran 40. Three perfusion pressures were tested: 50, 100, and 150 mm Hg. Two hundred eighty vessels were subjected to pressures of 50, 150, or 300 mm Hg using saline or STHC solution at 22 degrees C or STHC solution at 4 degrees C, for 10 or 60 seconds. The vessels were investigated in organ baths. Contractility was tested with the thromboxane analogue U-46619, acetylcholine was used to investigate EDR, and papaverine to elicit endothelium-independent relaxation. RESULTS: Flush-perfusion with cold STHC solution for 5 minutes at a perfusion pressure of 50 or 100 mm Hg affected neither contractility nor EDR. Vessels exposed to a flush-perfusion pressure of 150 mm Hg for 1 or 5 minutes lost 39% (p < 0.001) and 53% (p < 0.001) of their contractility, respectively. Flush-perfusion at 150 mm Hg for 1 minute did not affect EDR, whereas 5 minutes' perfusion caused a reduction of 7% (p < 0.05). A repetition of these experiments using STHC solution with 3.5% dextran 40 added gave no significantly different results. The impairment in contractility and EDR seen after perfusion at 150 mm Hg for 5 minutes disappeared after transplantation and reperfusion for 7 days. The vessels could be distended with saline or STHC solution at a pressure of 150 mm Hg without affecting contractility at 22 degrees C. At 4 degrees C, however, this pressure was harmful to contractility. Distention at a pressure of 300 mm Hg almost abolished contractility and 7 days after transplantation there had not yet been any recovery of contractility, but 30 days after transplantation the grafts had regained their normal contractility. CONCLUSIONS: Cold STHC solution, with or without dextran 40, can be used with a perfusion pressure of 100 but not 150 mm Hg without impairing EDR or vascular smooth muscle function.
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34.
  • Karpman, D, et al. (författare)
  • von Willebrand factor mediates increased platelet retention in recurrent thrombotic thrombocytopenic purpura
  • 1997
  • Ingår i: Thrombosis and Haemostasis. - 0340-6245. ; 78:6, s. 62-1456
  • Tidskriftsartikel (refereegranskat)abstract
    • The plasma cryoprecipitate of two brothers with recurrent thrombotic thrombocytopenic purpura (TTP) was previously found to mediate increased platelet retention and contain ultra-large von Willebrand factor (vWF) multimers during remissions. We conducted this study to examine if vWF is involved in the increased platelet retention in TTP. Platelet retention decreased when the patients' plasma was incubated with a monoclonal antibody directed to the vWF epitope which interacts with the platelet receptor glycoprotein Ib or when incubated with a Fab-fragment directed to the platelet receptor glycoprotein IIb/IIIa. Replacement of patient vWF with an equivalent concentration of a factor VIII/vWF concentrate containing no ultra-large vWF multimers was accompanied by a normalization of platelet retention. These results indicate that vWF is involved in the increased platelet retention. Analysis of polymorphic markers in the vWF gene demonstrated that a recessive mutation in this gene is unlikely.
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35.
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36.
  • Malmgren, Helge, 1945, et al. (författare)
  • A longitudinal pilot study of the Rorschach as a neuropsychological instrument
  • 1997
  • Ingår i: Carlsson, A.M. et al (red), Research into Rorschach and Projective Methods. Selected papers from the First Nordic Symposium on Research into Rorschach and Projective Methods. Uppsala, Sweden, August 1995.. - 9197299618 ; , s. 117-39
  • Konferensbidrag (refereegranskat)abstract
    • Six patients with mixed organic mental disorders after a neurosurgical procedure were tested repeatedly with the Roschach method according to the classical European school (Bohm). The results show that the Rorschach may be a valuable method for following the gradual worsening or improvement of organic mental conditions. Hermann Rorschach's original description of the test profile of patients with Korsakoff's amnestic syndrome was also supported by the data.
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37.
  • Malmgren, Helge, 1945 (författare)
  • Without a proper definition, you do not see the phenomenon
  • 1997
  • Ingår i: Consciousness and its pathologies. San Diego, CA, May 17-18, 1997.
  • Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
    • At the beginning of the century, pioneer psychiatrists in the classical German school (Kraepelin, Bonhoeffer) had established beyond reasonable doubt the existence of a certain organic mental syndrome or “reaction form”, variously named “Reizbare Schwäche” (irritable weakness) or “Emotionell-hyperaestetisches Schwächezustand” (emotional-hypersensitive weakness state). This reaction form is typically manifested by concentration difficulties, mental fatiguability, secondary memory disturbances, irritability and emotional lability. The term “astheno-emotional disorder” (AED) has recently been suggested. Patients showing this constellation of symptoms are very common in all parts of organic psychiatry, for example after moderate trauma to the brain, in chronic intoxications, in certain chronic infectious states, in endocrine disorders, as the initial manifestation of a brain tumour, after an intracranial bleeding, and so on. Mild forms of the same disorder are sometimes met with in which no organic cause can be found but where the patient has instead suffered great mental stress. The condition usually affects the patients’ ability to work and is often socially handicapping. In spite of the importance of AED, and in spite of its being well-known to most practitioners in each of the separate areas where it occurs, academic psychiatry has displayed very little interest in the condition during the last 40 years, and the major diagnostic systems of today do not allow for a unitary classification of these cases. For example, in DSM-IV a certain share of the mild cases would receive the diagnosis “mild cognitive disorder”, which would however fit neither mild cases with dominating emotional lability nor any of the (equally common) more severe cases. In this paper, I suggest the following causes of the present situation concerning the diagnosis of AED: (1) The astheno-emotional syndrome is often complicated by secondary, psychogenic reactions such as anxiety, feelings of tension and depressive mood, which can be difficult to disentangle from the primary symptoms. Many earlier classificatory attempts in this area (often in terms of “neurasthenia”) stumbled on a failure to distinguish the primary from the secondary symptoms. (2) The fact that the primary symptoms can themselves be psychogenic in nature, and the fact that the etiology cannot always be known for certain, entail that the disorder has to be delimited without recourse to causes. Many systems instead prefer seperate diagnoses for psychogenic cases. (3) Clinically, cases of AED form a continuum, ranging from very mild disturbances without clinical import to severe disturbances justifying a global diagnosis of dementia. Most diagnostic systems of today do not allow for such large-scale gradations of the severity of a disorder. (4) The conceptual apparatus which is used to describe symptoms is often too coarse to be able to distinguish typical symptoms of AED from similar symptoms which do not belong to this disorder. A clear examples of this is “memory difficulties”, which can refer either to a primary memory disturbance of the kind seen in Korsakov’s amnestic disorder or to secondary effects of concentration difficulties, as in mild AED. Another example is the term “emotional disturbance”, which does not differentiate between the emotional flattening typically seen in severe frontolimbic injuries and the emotional instability which is very common in AED. (5) The operationalistic bias in several recent systems of psychiatric classification prohibits hypothetical diagnoses based on knowledge of the interaction between different psychiatric disorders. From longitudinal studies of patients it is clear that the emotional lability and the manifest fatiguability of a patient with AED can both be completely neutralized if the same patient also suffers an emotional flattening. This means that the diagnosis of AED cannot be completely operationalized in terms of present symptoms. (6) The isolation of different parts of organic psychiatry from each other and from general psychiatry implies that few psychiatrists have a sufficiently broad experience to see the full spectrum of AED.
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38.
  • Samuelsson, Lars, et al. (författare)
  • Scoliosis and trunk asymmetry in upper limb transverse dysmelia
  • 1997
  • Ingår i: Journal of Pediatric Orthopaedics. - : Ovid Technologies (Wolters Kluwer Health). - 0271-6798 .- 1539-2570. ; 17:6, s. 769-72
  • Tidskriftsartikel (refereegranskat)abstract
    • The incidence of scoliosis and trunk asymmetry were studied in 60 patients with upper limb dysmelia of the transverse type. The evaluations were based on radiographic measurements of the spine and scoliometer readings of the angle of trunk rotation (ATR), which were correlated with the side and level of the limb deficiency and also with leg length-inequality (LLI). Nineteen patients (31%) had a scoliosis between 10 and 19 degrees, whereas the curves were between 5 and 10 degrees in another 30 patients and the remainder had no measurable curve. The scoliosis seemed at least partly to be of postural origin as LLI significantly correlated with the direction of the curves, but there was no correlation between the Cobb angles and the magnitude of LLI. The scoliometer readings did not correlate with the scoliosis or LLI. Our findings indicate that most patients with upper limb transverse amputations do not develop a significant scoliosis. A scoliometer screen has a low positive predictive rate for scoliosis and the diagnosis of scoliosis requires a radiograph of the spine.
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39.
  • Steen, Stig, et al. (författare)
  • Successful transplantation of lungs topically cooled in the non-heart-beating donor for 6 hours
  • 1997
  • Ingår i: Annals of Thoracic Surgery. - 1552-6259. ; 63:2, s. 345-351
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The aim of this study was to transplant lungs that had been topically cooled in the non-heart-beating donor for 6 hours, using the most challenging evaluation method possible, namely single-lung transplantation followed by immediate contralateral pneumonectomy. METHODS: Domestic pigs were used (6 donors and 6 recipients) with a mean body weight of 59 +/- 3 kg. Ventricular fibrillation was induced, and after 1 minute, cardiac massage was started and heparin (5 mg/kg body weight) was given via a central venous catheter. Cardiac massage was continued for 10 minutes, during which the pig was ventilated with 50% oxygen. The pleural cavities were opened and the tracheal tube disconnected from the ventilator, with the result that both lungs deflated. Saline slush was placed in both pleural cavities so that it completely covered the lungs. Within 40 minutes the lung core temperature was less than 10 degrees C, and it was kept around 8 degrees C for 6 hours by adjusting the amounts of ice slush. The left lung was then harvested and transplanted into a prepared recipient, followed by right pneumonectomy within 46 +/- 4 minutes, thus making the recipient pig 100% dependent on the transplanted cadaver lung. RESULTS: The mean ischemic time for the cadaver lungs was 8 hours and 2 minutes (range, 7 hours and 25 minutes to 8 hours and 59 minutes). All animals remained in excellent condition throughout the 24-hour observation period, with arterial oxygen tensions of approximately 225 mm Hg, or 30 kPa (inspired oxygen fraction, 0.5). CONCLUSIONS: Lungs from non-heart-beating donors may be used for transplantation if heparinization and topical cooling can be initiated within minutes of irreversible cardiac arrest.
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40.
  • Svenmarker, Staffan, et al. (författare)
  • Clinical effects of the heparin coated surface in cardiopulmonary bypass
  • 1997
  • Ingår i: European Journal of Cardio-Thoracic Surgery. - : Oxford University Press. - 1010-7940 .- 1873-734X. ; 11:5, s. 957-964
  • Tidskriftsartikel (refereegranskat)abstract
    • OBJECTIVE: In a randomised study of 120 patients, undergoing primary operation for coronary heart decease, two groups were investigated as regards to the effects of heparin coated cardiopulmonary bypass on brainfunction parameters and general clinical outcome. The study group (n = 56) was perfused using an extra-corporeal circuit treated with covalent bonded heparin; the control group (n = 59) used an identical set-up without heparin treatment. Systemic heparin doses were calculated to achieve ACT levels of 250 and 500 s, respectively. Postoperative course was evaluatedby examining a set of clinically relevant parameters including a detailed registry of postoperative deviations. Brain function was assessed by the biochemical marker S-100 and tests of memory performance.RESULTS: There were several signs of reduced operative trauma in the study group. Hospital stay was reduced by nearly 1 day (P < 0.05). Time on postoperative ventilatory support was approximately 4 h shorter (P = 0.009). Chest drain blood loss was decreased both at 8 (P = 0.01) and 24 h (P = 0.007) postoperatively. Body temperature was lower after surgery and especially on days 2 (P = 0.03) and 3 (P = 0.01). Perioperative creatinine elevation was significantly reduced (P = 0.03). Neurological deviations were fewer (P =0.01). Brain function assessment revealed reduced plasma levels of S- 100 both at termination of cardiopulmonary bypass (P = 0.008) and 7 h later (P= 0.04). However, no remediation of memory impairment could be demonstrated.CONCLUSIONS: Cardiopulmonary bypass with covalent bonded heparin attached to the extra-corporeal circuit in combination with a reduced systemic heparin dose seems to reduce safely and effectively the operative stress to the patient. There were also signs of improved cerebral protection.
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