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- Blomberg, S, et al.
(författare)
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Thoracic epidural anaesthesia in patients with unstable angina pectoris
- 1989
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Ingår i: European Heart Journal. - : Oxford University Press. - 0195-668X .- 1522-9645. ; 10:5, s. 437-444
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Tidskriftsartikel (refereegranskat)abstract
- The effect of high thoracic epidural anaesthesia with intermittent epidural bolus injections of bupivacaine (2.5 or 5 mg ml-1) was studied in 28 patients with unstable angina pectoris. The majority of the patients had a history of previous acute myocardial infarction(s) and/or angina pectoris and severe coronary artery disease. All patients were treated wth nitroglycerin infusion for gt;24 h and were included in the study if they had chest pain, not caused by acute myocardial infarction, at bed rest or recurrent anginal pain at rest < 2 days after infarction. 4.4 ± 0.3 ml of bupivacaine induced a blockade of the upper seven sympathetic segments ( Th1-7) for 98 ± 9min. Heart rate decreased significantly from 70 ± 3 to 64 ± 3 beats min-1 while blood pressure was unaffected by thoracic epidural anaesthesia. In 27 patients (96%) the anaesthesia induced complete analgesia. Nitroglycerin infusion was discontinued definitely within 3 h in 26 patients (93%) and pain was thereafter controlled by means of thoracic epidural anaesthesia as the sole treatment in 23 patients (82%) and as the major treatment in 25 patients (89%). Twenty-one patients (75%) were fully mobilized and stabilized. Treatment with thoracic epidural anaesthesia lasted for 6.0 ± 1.1 days. The number of daily epidural injections decreased significantly with time from 2.7 ±0.3 the first day to 0.9 ± 0.3 the fourth day (P>0.01, n = 19). Two patients developed acute myocardial infarction during the anaesthesia treatment period, and one of these patients died. Exercise stress testing was performed on eight patients three to five days after the start of thoracic epidural anaesthesia. At a comparable workload, ST-segment depression was significantly (P>0.05) less pronounced during anaesthesia ( − 0.6 ± 0.1 mm) compared with control ( − 1.3 ± 0.2mm). The respective heart rate values were 95 ± 7 and 107 ± 7 beats min -1 (P > 0.05), while systolic or diastolic blood pressure did not differ between the two conditions. We conclude that blockade of cardiac sympathetic afferents and efferents by means of thoracic epidural anaesthesia can effectively treat pain and stabilize patients with unstable angina pectoris refractory to medical treatment. Furthermore, thoracic epidural anaesthesia attenuates stress-induced myocardial ischaemia; thus, it may be an efficient supplementary treatment for the control of pain and for stabilizing patients with unstable angina pectoris during diagnostic procedures and prior to coronary surgery or angioplasty.
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- Moestrup, T, et al.
(författare)
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Hepatitis B virus-DNA in the serum of patients followed-up longitudinally with acute and chronic hepatitis B
- 1985
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Ingår i: Journal of Medical Virology. - : Wiley. - 1096-9071 .- 0146-6615. ; 17:4, s. 337-344
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Tidskriftsartikel (refereegranskat)abstract
- Sera from 79 patients with acute self-limiting hepatitis, 17 patients with acute hepatitis B evolving into chronic HBsAg carriership, and 43 chronic HBsAg carriers without a history of acute hepatitis were analyzed for presence of hepatitis B virus (HBV)-DNA by a molecular hybridization technique. In acute self-limiting hepatitis, HBV-DNA was cleared within a few weeks after the onset of clinical symptoms. The longest period of DNA positivity observed in this group was 42 days. In 29 of 52 patients HBV-DNA was cleared before HBeAg disappeared. Among 17 patients who became chronic HBsAg carriers, HBV-DNA was present for more than 6 months in all but one. Most of the HBsAg carriers eventually cleared HBV-DNA. The DNA clearance frequently preceeded the conversion of HBeAg to anti-HBe. Thus, in many patients there was a transitional period with HBeAg but without HBV-DNA. HBV-DNA was found to be a better index of impending chronicity than HBeAg since persistence of HBeAg for more than 42 days was noted in 10% of the patients who nevertheless cleared HBsAg within 6 months. By that time all those patients had turned negative for HBV-DNA. On the other hand, in 16 of the 17 patients who became chronic carriers of HBsAg, HBV-DNA as well as HBeAg persisted for more than 6 months. The present results also suggest that infectivity in acute hepatitis B is a feature mainly of the presymptomatic and early symptomatic period.
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- Siegbahn, Per E.M., et al.
(författare)
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A COMPARISON OF THE ON-TOP DISSOCIATION OF H-2 ON NI(100) AND CU(100)
- 1989
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Ingår i: Theoretica Chimica Acta. - 0040-5744. ; 75:2, s. 143-159
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Tidskriftsartikel (refereegranskat)abstract
- The on-top dissociations of H2 on Ni(100) and Cu(100) are studied using a cluster approach. Correlation effects are accounted for through the use of CASSCF and CCI methods. The central metal atom is treated with all its electrons whereas the other cluster atoms are described by recently developed one electron ECP's. A molecular chemisorbed H2 state on nickel, similar to that recently observed experimentally, was identified in the cluster calculations and also for the triatomic NiH2. No such state was found on copper. The large differences found for the on top dissociation of H2 on nickel and copper are attributed solely to the difference in 3d orbital occupation. The parallel between the on top dissociation reaction on the cluster and the dissociation on a single atom is also studied. While the neutral triatomic NiH2 represents a qualitatively correct model in the nickel case, the negatively charged CuH 2 – is required as a model in the copper case.
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