| 1. |
- Lindén, Thomas, 1962, et al.
(författare)
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Risk of central pontine myelinolysis in the treatment of severe hyponatremia
- 1989
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Ingår i: Läkartidningen. - 0023-7205. ; 86:20, s. 1905-7
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Tidskriftsartikel (refereegranskat)abstract
- Central pontine myelinolysis is a life-threatening condition involving the demyelination of axons in certain areas of the brain. It has been shown almost invariably to occur in connection with hospital care. In recent years, a connection has been noted between the rapid restitution of low serum sodium and the development of the condition. In this review, the most recent scientific information is summarized. It is concluded that the risk should always be considered in treating a hyponatremic patient. The serum sodium level should be raised slowly and the acute treatment ended before normal serum sodium levels are reached, ie when the patient is still slightly hyponatremic.
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| 2. |
- Andersson-Wenckert, Ingrid, et al.
(författare)
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Anevac-D, a new system for close scavenging of anesthetic gases in dental practice
- 1989
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Ingår i: Scandinavian Journal of Dental Research. - 0029-845X. ; 97:5, s. 456-64
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Tidskriftsartikel (refereegranskat)abstract
- Anevac-D, a new system for close scavenging of anesthetic gases in dental practice is described. It consists of a rubber nose mask surrounded by an outer rigid shell and a chin scavenger. A vacuum in the slot between the nose masks provides scavenging of gases escaping from the inner mask. Gases escaping from the mouth are evacuated mainly by the skin scavenger. The efficiency of this system was assessed in healthy volunteers using argon as a tracer gas. Mass spectrometry was used for measurement of inspired, expired, and scavenged gas concentrations. The scavenging efficiency of the complete system was around 80% and was not affected by poor patient cooperation. It decreased to about 65% when the chin scavenger was removed. The dentist's exposure was measured by sampling of argon in the breathing zone by a Saran system. The average 4-min exposure varied between 90 and 250 ppm depending on system configuration and patient cooperation. Patient acceptance and clinical applicability were judged good. It is concluded that the Anevac-D system provides excellent scavenging properties and exposure levels well within the official recommendations by the Swedish Board of Occupational Safety and Health.
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| 3. |
- Borg, T, et al.
(författare)
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A porcine model of early adult respiratory distress syndrome induced by endotoxaemia.
- 1985
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Ingår i: Acta Anaesthesiologica Scandinavica. - 0001-5172 .- 1399-6576. ; 29:8, s. 814-30
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Tidskriftsartikel (refereegranskat)abstract
- To study the pathophysiology of early adult respiratory distress syndrome (ARDS) induced by sepsis, spontaneously breathing pigs under ketamine anaesthesia were investigated. Twenty animals were infused i.v. with E. coli endotoxin (10 micrograms . h-1 . kg-1) over 6 h, and ten control animals received physiological saline. In the controls, cardiac output (Qt) and O2 delivery decreased slightly. There were no changes in pulmonary gas exchange, pulmonary haemodynamics or extravascular lung water (EVLW). The polymorphonuclear (PMN) leucocyte count gradually increased, while the platelet count decreased slightly. Endotoxin infusion caused profound deterioration of pulmonary gas exchange, a marked rise in pulmonary vascular resistance (PVR) and a moderate increase in EVLW. The pulmonary dysfunction was not attributable to the pulmonary oedema per se, whereas a "dry" ventilation/perfusion inequality played an important role. The "responders" (peak venous admixture greater than 20%; n = 14) were characterized by higher Qt and lower PVR than the "non-responders". Qt declined progressively, especially in non-survivors. O2 delivery decreased considerably. Metabolic acidosis probably indicated oxygen deficit. Eleven of 20 animals died during the observation period. Mortality was related more to the imbalance between O2 delivery and oxygen demand than to the deterioration in pulmonary gas exchange. The PMN count decreased markedly while the gradual decline in platelet count was similar to that in the controls. Lung microscopy revealed PMN accumulation in the microvasculature, moderate interstitial oedema and microvascular blood stasis. Our porcine model, which closely mimics early ARDS in man, will be useful in further studies of the pathophysiological pathways and the treatment of this syndrome.
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| 4. |
- Borg, T, et al.
(författare)
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Prophylactic and delayed treatment with indomethacin in a porcine model of early adult respiratory distress syndrome induced by endotoxaemia.
- 1986
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Ingår i: Acta Anaesthesiologica Scandinavica. - 0001-5172 .- 1399-6576. ; 30:1, s. 47-59
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Tidskriftsartikel (refereegranskat)abstract
- The effects of prophylactic and delayed treatment with indomethacin were evaluated in a porcine model of early adult respiratory distress syndrome (ARDS) induced by endotoxaemia. Spontaneously breathing pigs under ketamine anaesthesia were infused i.v. with E. coli endotoxin (10 micrograms . h-1 . kg-1) over 6 h. Twenty animals received endotoxin without treatment. Eight animals were pretreated with indomethacin i.v., 5 mg . kg-1 in 30 min, followed by further infusion at a rate of 2 mg . h-1 . kg-1. Ten animals received the same dosage of indomethacin beginning 2 h after the start of endotoxin infusion. Pretreatment with indomethacin inhibited the endotoxin-induced impairment in pulmonary gas exchange, but did not prevent pulmonary oedema. The pulmonary hypertension was counteracted. Oxygen delivery did not improve, because of a marked reduction in cardiac output (Qt). Systemic vascular resistance (SVR) increased markedly, and mean arterial pressure (MAP) was higher. Survival was improved. Delayed indomethacin treatment prevented a further deterioration in pulmonary gas exchange and restored it towards the baseline level. The pulmonary oedema was not counteracted, while the pulmonary hypertension was reduced. O2 delivery was not restored, owing to the greater decrease in Qt compared with the untreated endotoxin group. SVR increased considerably, and MAP was better maintained. Survival was not improved. These results indicate that cyclo-oxygenase inhibitors might benefit pulmonary gas exchange in human ARDS. Drugs which interfere with arachidonate metabolism will probably be of great importance in the prophylaxis, in particular, and also in the treatment of ARDS.
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| 5. |
- Hvarfner, Andreas, et al.
(författare)
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Indices of mineral metabolism in relation to blood pressure in a sample of a healthy population
- 1986
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Ingår i: Acta Medica Scandinavica. - 0001-6101. ; 219:5, s. 461-468
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Tidskriftsartikel (refereegranskat)abstract
- Indices of mineral metabolism in blood and urine were analysed in relation to blood pressure in 97 healthy subjects aged 16-82 years. In a multivariate analysis, after allowing for the effects of sex, body mass index (BMI) and age, there was an inverse relationship between plasma level of ionized calcium and mean blood pressure (MBP) (beta = -50.0 mmHg/mmol/l P-ionized calcium, p = 0.0005). In univariate analyses MBP also showed statistically significant inverse relationships with plasma ionized calcium, serum phosphate and renal threshold concentration of phosphate; positive relationships to MBP were found for fasting urinary excretion of calcium and cyclic adenosine monophosphate. However, when examined multivariately, only the relation between MBP and plasma ionized calcium persisted. This study supports previous findings of an inverse relationship between blood pressure and serum ionized calcium and extends the observations to the physiological range. It is further evident from this study that BMI and age should be taken into account in analyses of the relationship between blood pressure and mineral metabolism.
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| 6. |
- Joborn, H, et al.
(författare)
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Serum electrolytes and parathyroid hormone in patients in a coronary care unit
- 1989
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Ingår i: Journal of Internal Medicine. - 1365-2796. ; 225:1, s. 9-14
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Tidskriftsartikel (refereegranskat)abstract
- A prospective study was carried out in 499 patients admitted to a coronary care unit (CCU) in order to evaluate the incidence of clinically significant electrolyte disturbances. Low serum potassium values (less than 3.6 mmol l) occurred in 7% of the CCU patients and low serum magnesium values (less than 0.70 mmol l-1) in 6%. Few patients had low values of both these ions (1.9%). In 49 patients the contents of these electrolytes in muscle biopsies were similar to the values of control subjects and were unrelated to treatment with diuretics. Serum calcium was determined in 444 of the patients and was above the reference range in 11 (2.5%). If we consider their concomitant parathyroid hormone (PTH) values, primary hyperparathyroidism was likely to occur in at least seven patients (1.5%). Patients with acute myocardial infarction (AMI) had mean PTH and electrolyte values similar to those of individuals without this disease. In conclusion, the present study indicates that clinically important disturbances of magnesium, potassium or calcium homeostasis are rare among unselected patients admitted to a CCU.
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