| 1. |
- Bozovic, Gracijela, et al.
(författare)
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Imaging of the Lungs in Organ Donors and its Clinical Relevance : A Retrospective Analysis
- 2017
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Ingår i: Journal of thoracic imaging. - Philadelphia, USA : Lippincott Williams & Wilkins. - 0883-5993 .- 1536-0237. ; 32:2, s. 107-114
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The aim of the study was to retrospectively evaluate the diagnostic imaging that potential lung donors undergo, the reader variability of image interpretation and its relevance for donation, and the potential information gained from imaging studies not primarily intended for lung evaluation but partially including them.Materials and methods: Bedside chest radiography and computed tomography (CT), completely or incompletely including the lungs, of 110 brain-dead potential organ donors in a single institution during 2007 to 2014 were reviewed from a donation perspective. Two chest radiologists in consensus analyzed catheters and cardiovascular, parenchymal, and pleural findings. Clinical reports and study review were compared for substantial differences in findings that could have led to a treatment change, triggered additional examinations such as bronchoscopy, or were considered important for donation.Results: Among 136 bedside chest radiographs, no differences between clinical reports and study reviews were found in 37 (27%), minor differences were found in 28 (21%), and substantial differences were found in 71 (52%) examinations (P<0.0001). In 31 of 42 (74%) complete or incomplete CT examinations, 50 of 74 findings with relevance for lung donation were not primarily reported (P<0.0001).Conclusions: The majority of donor patients undergo only chest radiography. A targeted imaging review of abnormalities affecting the decision to use donor lungs may be useful in the preoperative stage. With a targeted list, substantial changes were made from initial clinical interpretations. CT can provide valuable information on donor lung pathology, even if the lungs are only partially imaged.
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| 2. |
- Jungner, Mårten, et al.
(författare)
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Blood-brain barrier permeability following traumatic brain injury.
- 2016
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Ingår i: Minerva Anestesiologica. - 1827-1596. ; 82:5, s. 525-533
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Brain edema and intracranial hypertension is deleterious after traumatic brain injury (TBI), but the underlying pathophysiology is complex and poorly understood. One major subject of controversy is the time course and extent of blood-brain barrier (BBB) dysfunction following trauma, and previous studies in humans have only provided semi-quantitative data. The objective of the present study was therefore to quantify changes in BBB-permeability in the early course of TBI, when brain edema is still evolving. METHODS: Sixteen non-consecutive brain trauma patients and two controls were included. Following i.v. injection of iohexol and CT perfusion scans, patients were scanned eight times from 4 to 25 minutes. Blood to brain transfer constant (Ki) for iohexol (molecular weight 821 D), reflecting permeability and available area for diffusion, was calculated offline by Patlak plot analysis of the enhancement curves of intracerebral large venous vessels and pericontusional brain parenchyma. RESULTS : In non-ischemic tissue surrounding contusions and hematomas Ki was increased 2-to 10-fold compared to normal tissue, reaching maximal values of 0.5 mL/min/100 g. In non-injured areas and in controls Ki was about 0.06 mL/min/100 g. The increase was more pronounced in the most severely injured patients, and was detectable within 24 hours after trauma and up to five days after. CONCLUSIONS: Our results suggest that traumatic brain injury is associated with early focal increases in small molecular BBB-permeability. The results indicate that in the injured brain, capillary hydrostatic and oncotic pressures may influence edema formation.
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| 3. |
- Mohanty, Tirthankar, et al.
(författare)
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Neutrophil extracellular traps in the central nervous system hinder bacterial clearance during pneumococcal meningitis
- 2019
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Ingår i: Nature Communications. - : Springer Science and Business Media LLC. - 2041-1723. ; 10:1, s. 1667-1667
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Tidskriftsartikel (refereegranskat)abstract
- Neutrophils are crucial mediators of host defense that are recruited to the central nervous system (CNS) in large numbers during acute bacterial meningitis caused by Streptococcus pneumoniae. Neutrophils release neutrophil extracellular traps (NETs) during infections to trap and kill bacteria. Intact NETs are fibrous structures composed of decondensed DNA and neutrophil-derived antimicrobial proteins. Here we show NETs in the cerebrospinal fluid (CSF) of patients with pneumococcal meningitis, and their absence in other forms of meningitis with neutrophil influx into the CSF caused by viruses, Borrelia and subarachnoid hemorrhage. In a rat model of meningitis, a clinical strain of pneumococci induced NET formation in the CSF. Disrupting NETs using DNase I significantly reduces bacterial load, demonstrating that NETs contribute to pneumococcal meningitis pathogenesis in vivo. We conclude that NETs in the CNS reduce bacterial clearance and degrading NETs using DNase I may have significant therapeutic implications.
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| 4. |
- Reinstrup, Peter, et al.
(författare)
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Cerebral blood volume (CBV) in humans during normo- and hypocapnia: influence of nitrous oxide (N(2)O)
- 2001
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Ingår i: Anesthesiology. - 1528-1175. ; 95:5, s. 1079-1082
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: It is generally argued that variations in cerebral blood flow create concomitant changes in the cerebral blood volume (CBV). Because nitrous oxide (N(2)O) inhalation both increases cerebral blood flow and may increase intracranial pressure, it is reasonable to assume that N(2)O acts as a general vasodilatator in cerebral vessels both on the arterial and on the venous side. The aim of the current study was to evaluate the effect of N(2)O on three-dimensional regional and global CBV in humans during normocapnia and hypocapnia. METHODS: Nine volunteers were studied under each of four conditions: normocapnia, hypocapnia, normocapnia + 40-50% N(2)O, and hypocapnia + 40-50% N(2)O. CBV was measured after (99m)Tc-labeling of blood with radioactive quantitative registration via single photon emission computer-aided tomography scanning. RESULTS: Global CBV during normocapnia and inhalation of 50% O(2) was 4.25 +/- 0.57% of the brain volume (4.17 +/- 0.56 ml/100 g, mean +/- SD) with no change during inhalation of 40-50% N(2)O in O(2). Decreasing carbon dioxide (CO(2)) by 1.5 kPa (11 mmHg) without N(2)O inhalation and by 1.4 kPa (11 mmHg) with N(2)O inhalation reduced CBV significantly (F = 57, P < 0.0001), by 0.27 +/- 0.10% of the brain volume per kilopascal (0.26 +/- 0.10 ml x 100 g(-1) x kPa(-1)) without N(2)O inhalation and by 0.35 +/- 0.22% of the brain volume per kilopascal (0.34 +/- 0.22 ml x 100 g(-1) x kPa(-1)) during N(2)O inhalation (no significant difference). The amount of carbon dioxide significantly altered the regional distribution of CBV (F = 47, P < 0.0001), corresponding to a regional difference in Delta CBV when CO(2) is changed. N(2)O inhalation did not significantly change the distribution of regional CBV (F = 2.4, P = 0.051) or Delta CBV/Delta CO(2) in these nine subjects. CONCLUSIONS: Nitrous oxide inhalation had no effect either on CBV or on the normal CBV-CO(2) response in humans.
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| 5. |
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| 6. |
- Bellner, Johan, et al.
(författare)
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Transkraniell dopplermätning avspeglar intrakraniellt tryck
- 2005
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Ingår i: Läkartidningen. - 0023-7205. ; 102:11, s. 840-844
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Tidskriftsartikel (refereegranskat)abstract
- Vid intrakraniell patologi, speciellt om patienten är medvetslös, är kunskap om det intrakraniella trycket av särskilt värde i neurointensivvård. Intraventrikulär kateter för mätning av intrakraniellt tryck har varit etablerad standard i årtionden. Exakta mätningar är möjliga endast genom invasiva tryckmätare. För att undersöka sambandet mellan intrakraniellt tryck och pulsatilt index, erhållet med transkraniell doppler, har vi genomfört en prospektiv studie. Registreringar av intrakraniellt tryck gjordes parallellt med alla dopplerundersökningar. En stark, signifikant korrelation sågs mellan intrakraniellt tryck och pulsatilt index med en korrelationskoefficient på 0,938. För detektion av ett intrakraniellt tryck >20 mm Hg i en population med intrakraniellt tryck mellan 10 och 40 mm Hg hade metoden – för alla mätningar – en sensitivitet på 0,83 och en specificitet på 0,99. Hos patienter med misstänkt förhöjt intrakraniellt tryck eller hos patienter där förhöjt intrakraniellt tryck måste uteslutas kan mätningar av pulsatilt index vara av stort värde.
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| 7. |
- Bozovic, Gracijela, et al.
(författare)
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Impact of donor chest radiography on clinical outcome after lung transplantation
- 2018
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Ingår i: Acta Radiologica Open. - : SAGE Publications. - 2058-4601. ; 7:6
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Tidskriftsartikel (refereegranskat)abstract
- BackgroundOrgan donation guidelines recommend a “clear” conventional bedside chest radiograph before lung transplantation despite only moderate accuracy for cardiopulmonary abnormalities.PurposeTo evaluate the influence of donor image interpretation on lung transplantation outcome in recipients by following early and late complications, one-year survival, and to correlate imaging findings and blood gas analysis with lung transplantation outcome in recipients.Material and MethodsIn 35 lung donors from a single institution clinical reports and study reviews of imaging findings of the mandatory bedside chest radiographs and blood gas analyses were compared with clinical outcome in 38 recipients. Hospitalization time, peri- and postoperative complications, early complications (primary graft dysfunction, infection), 30-day and one-year survival, and forced expiratory volume in 1 s percentage of predicted normal value (FEV1%) at one-year follow-up were analyzed.ResultsFindings in clinical reports and study reviews differed substantially, e.g. regarding reported decompensation, edema, infection, and atelectasis. No correlation was shown between imaging findings in clinical report or study review and blood gas analyses in the lung donors compared to postoperative outcome in recipients.ConclusionThe interpretation of the mandatory chest radiograph in its present form does not influence one-year outcome in lung transplantation. Larger imaging studies or a change in clinical routine including computed tomography may provide evidence for future guidelines.
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| 8. |
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| 9. |
- Dahm, S L, et al.
(författare)
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Charcoal as an airway isoflurane reflection filter
- 1998
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Ingår i: European Journal of Anaesthesiology. - : Ovid Technologies (Wolters Kluwer Health). - 1365-2346 .- 0265-0215. ; 15:2, s. 230-233
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Tidskriftsartikel (refereegranskat)abstract
- The isoflurane-saving and CO2-retaining effects of a charcoal filter were compared with a Siemens standard heat and moisture (HME) exchanger and an emptied specimen (dummy). Isoflurane was delivered during the inspiratory phase and consumption investigated at 10, 15 and 25 cycles min-1. The investigation was performed by ventilation with humidified air with a constant end-tidal CO2 and temperature. For a comparison, isoflurane was delivered in a conventional manner via the ventilator. The arrangement with a charcoal filter reduced the isoflurane consumption by a factor of 2.0-2.6, depending on ventilatory rate. Most of the saving was a result of the method of isoflurane delivery (factor 1.4-2.0), while adding the reflector gave a further reduction (factor 1.3-1.5). One circumstance that reduced the net efficiency of the charcoal filter was that it also reflected CO2; consequently, total minute ventilation had to be increased to maintain constant end-tidal CO2.
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| 10. |
- Diaz-Parejo, P, et al.
(författare)
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Cerebral energy metabolism during transient hyperglycemia in patients with severe brain trauma
- 2003
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Ingår i: Intensive Care Medicine. - : Springer Science and Business Media LLC. - 0342-4642 .- 1432-1238. ; 29:4, s. 544-550
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To study whether transient hyperglycemia adversely affects cerebral energy metabolism in patients with severe traumatic brain lesions. Design and setting: Prospective, nonrandomized study in the neurosurgical intensive care unit of a university hospital. Patients: 108 patients treated for severe traumatic brain lesions. Interventions: All patients were treated according to neurosurgical intensive care routine including monitoring of, intracranial pressure. One microdialysis catheter was inserted via a burr hole frontally to that used for the intraventricular catheter ("better" position). In patients with focal lesions one or more catheters were inserted into cerebral cortex surrounding an evacuated focal contusion or underlying an evacuated hematoma ("worse" position). Perfusion rate was 0.3 mul/min and samples were taken every. 30 or 60 min. The levels of glucose, pyruvate, lactate, glutamate, and glycerol were analyzed and displayed bedside. Measurements and results: There were 18 episodes of moderate (12-15 mmol/1) and 6 episodes of pronounced (>15 mmol/1) hyperglycemia. Moderate hyperglycemia did not change intracerebral levels of lactate, pyruvate, glutamate, glycerol, or lactate/pyruvate ratio. Lactate concentrations increased during pronounced hyperglycemia. Pronounced cerebral lactic acidosis and a moderate increase in interstitial glycerol concentration indicating cell membrane degradation was observed in a single patient with pronounced, long-lasting hyperglycemia. Conclusions: Cerebral energy metabolism was affected by transient hyperglycemia only at blood glucose concentration above 15 mmol/l as shown by a moderate increase in interstitial lactate level.
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