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Träfflista för sökning "hsv:(MEDICIN OCH HÄLSOVETENSKAP) hsv:(Klinisk medicin) hsv:(Allmän medicin) srt2:(1980-1989)"

Sökning: hsv:(MEDICIN OCH HÄLSOVETENSKAP) hsv:(Klinisk medicin) hsv:(Allmän medicin) > (1980-1989)

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  • Viitanen, Matti, 1950- (författare)
  • Long-term effects of stroke
  • 1987
  • Ingår i: digitalisering@umu. - Umeå : Umeå universitet. - 91-7174-312-X
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>Stroke, which has an increasing incidence with age, causes an irreversible brain damage which may lead to impairment, disability and decreased life satisfaction or death.</p><p>Risk factors for death, recurrent stroke and myocardial infarction, were analyzed in 409 stroke patients treated at the Stroke Unit, Department of Medicine, Umeå University Hospital, between Jan. 1, 1978 and Dec. 31, 1982. The causes of death were related with the time of survival. In fully co-operable (n=62) 4-6 year stroke survivors, the occurrence of motor and perceptual impairments, of self-care (ADL) disability and of self-reported decreased life satisfaction due to stroke was determined.</p><p>The probability of survival was 77% three months after stroke, 69% after one year, and 37% after five years. Multivariate statistical analysis indicated that impairment of consciousness was the most important risk factor for death followed by age, previous cardiac failure, diabetes mellitus, intracerebral hemorrhage and male sex. During the first week, cerebrovascular disease (90%) was the most dominant primary cause of death, from the second to the fourth week pulmonary embolism (30%), bronchopneumonia during the second and third months and cardiac disease (37%) later than three months after stroke. The risk of recurrence was 14% during the first year after stroke and the accumulated risk of stroke recurrence after 5 years was 37% after stroke. The estimated probability of myocardial infarction was 7% at one year and 19% at 5 years. High age and a history of cardiac failure increased the risk of recurrent stroke. The risk of myocardial infarction was associated with high age, angina pectoris and diabetes mellitus. The highest risk of epilepsy was found between 6 and 12 months after stroke. Motor impairment prevailed in 36% of the long-term survivors, perceptual impairments in up to 57% and decreased ADL-capacity in 32%. As regards ecological perception, perceptual function variables were distinctly grouped into low and high level perception which together with motor function explained 71% of the variance of self-care ADL. While levels of global and of domain specific variables of life satisfaction appeared stable in clinically healthy reference populations aged 60 and 80 years, the stroke had produced a decrease in one or more aspects of life satisfaction for 61% of the long-term survivors. Although significantly associated with motor impairments and ADL disability, these changes could not only be attributed to physical problems.</p>
  • Boman, Kurt, 1945- (författare)
  • On the clinical use of digitalis with reference to its prescription, maintenance therapy, intoxication and the patient's knowledge
  • 1983
  • Ingår i: digitalisering@umu. - Umeå : Umeå unviersitet.
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>Digitalis in one of the most frequently prescribed drugs, especially to elderly people. The prescription of cardiac glucosides (1978) was studied by using statistics from Apoteksbolaget (the National Corpora­tion of Swedish Pharmacies). There was a threefold difference in the sales of cardiac glucosides per 1000 inhabitants in the different primary care areas. Digoxin was prescribed to 90-98 per cent of the patients, with considerable variations in the dosages. Many other factors besides the cardio-vascular morbidity were likely to cause these differences.</p><p>Maintenance digitalis therapy has lately been questioned. In a retro­spective study, digitalis was discontinued in 141 geriatric patients without contraindications to digitalis withdrawal. Digoxin treatment seemed to be unnecessary in 108 patients (81 per cent), followed up two months after digoxin withdrawal. A long-term study (mean: 20,5 months) was carried out in these 108 patients. Digitalis therapy was reinstituted in 30 of 99 patients, equally distributed on the basis of clear, possible or uncertain indications. Significantly more patients (p&lt; 0,001) with atrial fibrillation compared with sinus rhythm were restarted. A prospective, randomized, double-blind placebo- controlled study in 39 out of 66 geriatric patients confirmed the results of the retrospective study. During a two-month period 32 of 37 patients (86 per cent) managed without digitalis. Eighteen out of 66 patients (27 per cent) presented contraindications to digoxin with­drawal. Those who needed digitalis were restarted mainly during the first nonth (mean: 18 days) following digoxin withdrawal.</p><p>Digitalis intoxication has been studied earlier, mainly in hospitalized patients. A clinical examination and ECG of a random sample of out­patients treated with digoxin shewed that about 5 per cent were certainly intoxicated and about 2 per cent suspected of being intoxi­cated.</p><p>Elderly patients are said to be more sensitive to digitalis. Eleven per cent of 66 geriatric patients were found, without doubt, to be digitalis intoxicated. The mean serum digoxin concentration was significantly higher in eight toxic patients compared with non-toxic patients, but 75 per cent of the toxic patients had serum digoxin con­centrations within or below therapeutic range. Five of these intoxi­cated patients did not need maintenance digitalis therapy.</p><p>A questionnaire of 361 patients in Skellefteå and Uppsala revealed that about 45 per cent had taken digitalis for more than five years. Approximately 85 per cent took one tablet daily and stated compliance. About one fifth did not know why they were taking digoxin and about half of the patients were uncertain if they were improved, by digitalis therapy. Although digitalis intoxication is such an important clinical problem, some 55 per cent did not know about digitalis's side-effects and some 50 per cent stated that no or insufficient information had been given. Only 15 per cent were satisfied with the information they had received. A significant negative correlation between digoxin dosages and the age of the patients was found.</p>
  • Karlson, Bo, et al. (författare)
  • On the influence of vitamin K-rich vegetables and wine on the effectiveness of warfarin treatment
  • 1986
  • Ingår i: Acta medica Scandinavica. - 0001-6101. ; 220:4, s. 347-350
  • Tidskriftsartikel (refereegranskat)abstract
    • <p>Thrombotest (TT) values were studied in patients fed an ordinary diet and on continuous and well controlled warfarin therapy because of deep venous thrombosis or pulmonary embolism. The aim was to characterize the effect of single and multiple administrations (daily during one week) of vitamin K1 (Konakion), vitamin K-rich vegetables such as spinach and broccoli, and table wine. Single administration of 250 micrograms vitamin K1, 250 g spinach, 250 g broccoli and 37.5 cl wine did not result in TT-values outside the therapeutic range. However, when Konakion, broccoli and spinach were given daily during one week the TT-values tended to rise above the therapeutic limit, requiring dose adjustment. On the basis of this study it appears that excessive intake of vitamin K-rich food and a moderate intake of alcohol on one occasion may be permitted during anticoagulant therapy.</p>
  • Lennmarken, Claes, 1948- (författare)
  • Skeletal muscle function and energy metabolism in various nutritional states : a clinical study
  • 1986
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>The clinical picture of the malnourished patient consists of loss of body fat and lean body mass resulting in weight loss and impaired vital organ function. Weakness and fatigue are often prominent symptoms arising from affected skeletal muscle in these patients.</p><p>Skeletal muscle is intimately involved in the process of body energy metabolism and its regulation. The effect of insufficient nutritional intake on skeletal muscle function and energy metabolism was studied in subjects, with various nutritional states. Involuntary muscle function was assessed in the adductor pollicis muscle after electrical stimulation of the ulnar nerve. Energy metabolites were measured in needle biopsy samples from the quadriceps femoris muscle.</p><p>After total starvation, muscle function was found to be altered and indicated a low rate of energy turn-over. In extremely obese patients, muscle function was also changed but indicated a high rate of energy turn-over. Semi-starved surgical patients had normal skeletal muscle function.</p><p>In anorexia nervosa patients 3-5 weeks of total patenteral nutrition largely normalized their deranged muscle energy metabolism. In the obese patients energy metabolism was found to be altered, indicated a high metabolic rate. This is probably a physiological adaptation to a high body weight. In semi-starved surgical patients normal contents of energy metabolites were found.</p><p>These findings indicate that major changes in the nutritional state, induced alterations in skeletal muscle energy metabolism. Skeletal muscle function was concomitantly altered indicating a relationship between energy metabolism and function in skeletal muscle. In moderately malnourished patients however, skeletal muscle function was normal.</p>
  • Steen, Lars, 1938- (författare)
  • Gastrointestinal involvement in familial amyloidosis with polyneuropathy a clinical study
  • 1983
  • Ingår i: digitalisering@umu. - Umeå : Umeå universitet.
  • Doktorsavhandling (övrigt vetenskapligt)abstract
    • <p>Familial Amyloidosis with Polyneuropathy was first recognized in Portugal and reported by Andrade in 1952. The disease is rare, but clustering of the patients has been reported from Portugal, Japan and northern Sweden. The gastrointestinal involvement in the Swedish form of the disease was studied in this investigation.</p><p>In a study of 52 patients on their first admission 47 displayed gastrointestinal symptoms in the form of severely altered bowel habits (intractable diarrhea and/or constipation). Steatorrhea was found in 30 out of 52 patients (58%) and an impaired d-xylose absorption in 26 out of 50 patients (52%). The steatorrhea was correlated to the degree of peripheral polyneuropathy as expressed by EMG-score. No relation could be established between steatorrhea or impaired d-xylose absorption with oral lactose and glucose tolerance tests indicating an intact entero- cyte function.</p><p>A follow-up study comprising 21 patients demonstrated that all patients ultimately developed gastrointestinal symptoms and that the prevalence of diarrhea became higher with the duration of the disease. In this study steatorrhea became more frequent and was significantly related to the duration.</p><p>Bile acid breath test, fecal fat determination and d-xylose tests were performed on 13 patients. Six patients with results indicating an increased bile acid deconjugation in the small bowel were treated with antibiotics for one week, after which the results had returned to normal in all. Four out of five patients with impaired d-xylose absorption before treatment also returned to normal after antibiotics. Three patients with diarrhea 3-7 times daily were considerably relieved after treatment both concerning general well-being and bowel movements.</p><p>The results give strong evidence that bacterial overgrowth of the small intestine is important in causing gastrointestinal dysfunction in this disease.</p><p>A histopathological study of the small intestinal mucosa on 27 patients showed that 84 percent were amyloid positive. The degree of amyloid infiltration did not correlate to the symptomatic state, steatorrhea or impaired d-xylose absorption. The surface ultrastructure was normal in all of 21 investigated cases.</p><p>Radiographical and endoscopi cal studies were performed on 43 patients altogether. Evidence of gastric stasis was found in 7 out of 37 patients investigated by means of gastric x-ray and in 7 out of 28 patients at gastroscopy. No characteristic radiological appearance of the disease could be shown in the small intestine, the colon or the gall bladder.</p><p>Nine patients who were operated on with the construction of an enterostomy were reported. The diversion of the fecal stream when the patients had diarrhea and were incontinent meant a considerable relief.</p>
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