Värnamo Sjukhus

Background: The incidence of non-palpable breast cancer is increasing due to widespread screening and neo-adjuvant therapies. Among the available tumor localization techniques, radio-guided occult lesion localization (ROLL) has largely replaced wire-guided localization (WGL). The aim of this study was to compare the ROLL and WGL techniques in terms of the effectiveness of isotopic marking of axillary sentinel lymph nodes and to assess patient perspectives along with surgeon and radiologist preferences. Methods: A single-center, prospective, randomized study enrolled 110 patients with non-palpable breast lesions (56 ROLL, 54 WGL). Breast type, tumor volume, location, histological and radiological features, and localization/surgical duration were evaluated in the context of sentinel lymph node marking using isotope (technetium-99m-labeled human serum albumin) and blue dye. Statistical analysis was performed with significance set at p < 0.05 and strong significance at p < 0.01. Results: A single-center, prospective, randomized study enrolled 110 patients with non-palpable breast lesions (56 ROLL, 54 WGL). Breast type, tumor volume, location, histological and radiological features, and localization/surgical duration were evaluated in the context of sentinel lymph node marking using isotope (technetium-99m-labeled human serum albumin) and blue dye. Statistical analysis was performed with significance set at p < 0.05 and strong significance at p < 0.01. Conclusions: While ROLL provided advantages in terms of patient comfort and logistical simplicity, WGL was superior for axillary sentinel lymph node marking, particularly in inner quadrant tumors, suggesting that WGL may be preferred in these cases.

To validate a model for predicting magnesium concentration in magnesium sulfate treatment in preeclampsia. Retrospective cohort study. Setting. Three secondary care hospitals, one accepting neonates from gestational week 28 + 0. Population. Women with preeclampsia undergoing magnesium sulfate treatment. Subjects initially received Zuspan treatment (4 g bolus and 1 g/h maintenance dose), commonly increased by individual titration. Main Outcome Measures. Difference in mean between measured and predicted magnesium concentration. Proportion of women reaching target concentration (>2 mM) in 25 h. 56 women were included, with 356 magnesium measurements available. Mean magnesium concentration was 1.82 mM. The prediction model overestimated magnesium concentration by 0.10 mM (CI 0.04-0.16) but exhibited no bias for weight, creatinine, or treatment duration. Weighted mean infusion rate was 1.22 g/h during 30 hours. Overall success rate in reaching target concentration was 54%, decreasing to 40% in women > 95 kg. Overall success rate at 8 hours was 11%. No toxic concentrations were found. Zuspan regimen is very safe, but slow to reach therapeutic concentrations-despite efforts of individual titration. Success rate is lower in heavy women, which is of particular importance considering their predisposition to develop preeclampsia. The validated pharmacokinetic model performs well and may be used to individually tailor treatment from the outset.

Mortality due to acute hypoxemic respiratory failure (AHRF) in patients with COVID-19 differs across units, regions, and countries. These variations may be attributed to several factors, including comorbidities, acute physiological derangement, disease severity, treatment, ethnicity, healthcare system strain, and socioeconomic status. This study aimed to explore the features of patient characteristics, clinical management, and staffing that may be related to mortality among three intensive care units (ICUs) within the same hospital system in South Sweden. We retrospectively analyzed ICU patients with COVID-19 and AHRF in Region Jönköping County, Sweden. The primary outcome was the 90-day mortality rate. We used univariate and multivariable logistic regression analyses to investigate the relationship of predictors with outcomes. Between March 15, 2020, and May 31, 2021, 331 patients with AHRF and COVID-19 were admitted to the three ICUs. There were differences in diseaseseverity, treatments, process-related factors and socioecomic factors between the units. These factors were related to 90-day mortality. After multivariable adjustement, age, severity of acute respiratory distress syndrome, and the number of nurses per ICU-bedindependently predicted 90-day mortality. Age, disease severity and nurse staffing, but not treatment or socioeconomic status, were independently associated with 90-day mortality among critically ill patients with AHRF due to COVID-19. We also identified variations in care related processes which may be a modifiable risk factor and warrants future investigation. This article is protected by copyright. All rights reserved.

Thiamine-responsive megaloblastic anemia (TRMA) is an autosomal recessive disorder characterized by the development of megaloblastic anemia, diabetes mellitus, and sensorineural deafness. We report on the first two Croatian patients with TRMA, compound heterozygotes for nonsense, c.373C > T; p.(Gln125Ter) and novel missense variant, c.1214C > G; p.(Thr405Arg) in SLC19A2 gene. The first was diagnosed at 4 months with diabetes mellitus and severe anemia requiring transfusions. As TRMA was suspected, thiamine therapy was immediately started to prevent further transfusions and insulin therapy. His brother developed extreme anemia at 3 weeks of age while waiting for the results of the genetic test. Severe anemia in this sibling may have been prevented if thiamine had been initiated earlier.

Iacono, Diego MD, PhD*,†,‡,§; Volkmann, Inga BSc*; Nennesmo, Inger MD, PhD∥; Pedersen, Nancy L. PhD¶,#; Fratiglioni, Laura MD, PhD¶; Johansson, Boo PhD**; Karlsson, David MD††; Winblad, Bengt MD, PhD*; Gatz, Margaret PhD¶,‡‡ Author Information

In Brief OBJECTIVE To identify and test the predictive power of potential independent risk factors of postpartum depressive symptoms during pregnancy and the perinatal period. METHODS We conducted a case-control study where 132 women with postpartum depressive symptoms were selected as an index group and 264 women without depressive symptoms as a control group. Data related to sociodemographic status, medical, gynecologic, and obstetric history, pregnancy, and perinatal events were collected from standardized medical records. RESULTS The strongest risk factors for postpartum depressive symptoms were sick leave during pregnancy and a high number of visits to the antenatal care clinic. Complications during pregnancy, such as hyperemesis, premature contractions, and psychiatric disorder were more common in the postpartum depressed group of women. No association was found between parity, sociodemographic data, or mode of delivery and postpartum depressive symptoms. CONCLUSION Women at risk for postpartum depression can be identified during pregnancy. The strongest risk factors, sick leave during pregnancy and many visits to the antenatal care clinic, are not etiologic and might be of either behavioral or biologic origin. The possibilities of genetic vulnerability and hormonal changes warrant further investigation to reach a more thorough understanding. The strongest risk factors for development of postpartum depressive symptoms were sick leave and many visits to the antenatal care clinic during pregnancy.

Molecular genetic techniques have increased the number of species recognized within the genus Mycobacterium. The clinical significance of these is uncertain and their pathogenic potential has still to be proven. We describe here a case of mycobacterial lymphadenitis in a Swedish boy, which supports the role of M. interjectum as a human pathogen.

Stimulation of gastric motility has been supposed to accelerate the healing of gastric ulcer. The combination of the prokinetic drug cisapride and the H2 blocker ranitidine was tested in the treatment of uncomplicated gastric ulcer. Cisapride, 20 mg twice daily (Cis), and ranitidine, 150 mg twice daily (Ran), were given as monotherapies and in the combination 20 mg cisapride and 150 mg ranitidine daily (Cis + Ran) for a maximum of 8 weeks. The study was multicentre, randomized, and double-blind. A total of 197 patients were included. Healing rates in the per-protocol analysis after 4 and 8 weeks' treatment were 61%/84%, 52%/69%, and 61%/92% for the Cis + Ran (n = 56), Cis (n = 58), and Ran (n = 59) treatment groups. No statistically significant difference in healing rates was seen when comparing Cis + Ran with the monotherapies. Symptom relief at the end of treatment was significantly better in the Ran group than in the Cis + Ran group with regard to epigastric pain (p = 0.01) and vomiting (p = 0.05). Patients' global evaluation of treatment was in favour of Ran in comparison with Cis + Ran treatment (p = 0.04). Combination of cisapride and ranitidine in the treatment of gastric ulcer did not enhance the healing rate or improve symptom relief in patients treated for uncomplicated gastric ulcer when compared with the monotherapies.

A series of 100 patients undergoing caesarean section was studied using ketamine 1.2 mg/kg as induction agent. Fifteen minutes prior to induction, atropine 0.25-0.5 mg and diazepam 1 mg was given intravenously as premedication. Anaesthesia was maintained with N2O:O2, FIO2 0.4. Once the umbilical cord was clamped, 0.2 mg fentanyl and 9 mg diazepam was given intravenously. Except for nitrous oxide, no more anaesthetic intravenous or inhalational agent was needed. Despite the fact that patients with known intrauterine asphyxia before the induction were included in the material, we found excellent Apgar scores (mean 9.1 at 1 min and 9.9 at 5 min). None of the patients reported awareness during the operation. Eight patients experienced pleasant dreams and three unpleasant. There were no hallucinations in the recovery area. The mental condition of the mothers after the operation was acceptable. It is suggested that ketamine can be used not only on special indications but also as a routine method for induction of anaesthesia for caesarean section.