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Biomedical subjects

B Brismar

Publications and source records attributed to B Brismar.

At least 91 records · Page 5Linked to original sources
PubMed1989

Imipenem concentrations in colorectal surgery and impact on the colonic microflora.

Twenty patients undergoing colorectal surgery were given, as prophylaxis, imipenem-cilastatin intravenously. Ten of them received a dose of 0.5/0.5 g of imipenem-cilastatin at induction of anesthesia, followed by subsequent doses of 0.5/0.5 g every 6 h for 48 h. The other 10 patients were given 1.0/1.0 g imipenem-cilastatin in the same way for 48 h. Samples from serum, intestinal mucosa, and feces were taken for analysis of imipenem concentrations during the day of surgery. The mean concentrations in serum at 1 h after the first imipenem dose were 15.9 +/- 1.7 micrograms/ml for the 0.5-g dose and 68.2 +/- 8.2 micrograms/ml for the 1.0-g dose. The mean half-lives were 1.5 and 1.4 h, respectively, and the mean areas under the serum concentration-time curve were 41.2 +/- 6.0 and 128.3 +/- 13.5 mg.h/liter, respectively. The imipenem concentrations in the intestinal mucosa varied between less than 0.1 and 3.6 mg/kg for the 0.5-g dose and 3.2 and 13.4 mg/kg for the 1.0-g dose. The concentrations in the fecal samples varied between less than 0.1 and 5.0 mg/kg for the 0.5-g dose and 0.7 and 11.3 mg/kg for the 1.0-g dose. Fecal samples were also collected during the investigation period for cultivation of aerobic and anaerobic bacteria. The aerobic bacteria--staphylococci, streptococci, enterococci, and enteroaerobic enterococci, and enterobacteria--were and anaerobic bacteria. The aerobic bacteria--staphylococci, streptococci, enterococci, and enterobacteria--were suppressed significantly during the imipenem prophylaxis period. Among the anaerobic bacteria, cocci, bifidobacteria, eubacteria, lactobacilli, clostridia, fusobacteria, and bacteroides decreased markedly during the same period. The microfloras were normalized after 2 weeks. There were no differences between the patients receiving 0.5-g doses of imipenem and those receiving 1.0-g of imipenem. No postoperative infections occurred.

Adult↗
PubMed1989

Pulmonary densities during anaesthesia. An experimental study on lung morphology and gas exchange.

The nature of dense areas in dependent lung regions regularly seen in anaesthetized humans was examined in a sheep model. During anaesthesia with muscle paralysis and mechanical ventilation dense areas in dependent lung regions could be seen by means of computerized tomography (CT). They had the same location and the same attenuation as in anaesthetized humans. Gas exchange impairment tended to increase in proportion to the size of the dense area on the CT scan. Microscopy showed that the densities in the sheep were atelectatic lung regions, with no or little interstitial oedema and only minor vascular congestion. The atelectatic lung tissue was sharply demarcated and the lung tissue in the immediate vicinity was well aerated, or even hyperinflated. Gravimetry showed the same amount of extravascular fluid and blood per unit lung weight in the atelectatic lung and in the aerated lung region. It is concluded that the densities appearing in dependent lung regions during anaesthesia are caused by atelectasis.

Anesthesia↗
PubMed1988

Aetiological and precipiating factors in wife battering. A psychosocial study of battered wives.

Forty-nine women who attended a surgical emergency department after being battered are the subjects of this prospective study. The childhood and adolescence of the women had been marked by abuse and violence in the parental home. Most of the women had suffered prolonged, repeated battering. Fifty-one per cent of the women and 88% of their male assailants were considered to be heavy consumers of alcohol and in over half of the cases of battering both the man and the women had been drinking. In most cases the women's own children were present when the mother was beaten. One third of the women stated that they were highly dependent on the man in question emotionally. It is concluded that social heredity, heavy consumption of alcohol and emotional dependence on the male assailant are major reasons for the woman's inability to break away from a relationship characterized by repeated battering.

Adult↗
PubMed1988

Thoracoabdominal restriction in supine men: CT and lung function measurements.

Thoracoabdominal restriction was brought on by means of a corset, and the subsequent effects on thoracic dimensions and lung tissue were studied by computerized tomography (CT) and by various lung function tests in supine healthy volunteers (mean age 30 yr). Restriction caused reductions in total lung capacity (helium equilibration) from mean 6.84 to 4.80 liters, in functional residual capacity (FRC) from 2.65 to 2.08 liters, and in vital capacity from 5.16 to 3.45 liters. Closing capacity (single-breath N2 washout) fell from 2.42 to 1.88 liters, thus matching the reduction in FRC. The static pressure-lung volume curve was shifted to the right by 1.5 cmH2O at 50% of total lung capacity. However, no change in the slope of the curve was observed. The diaphragm was moved cranially by 1.2 cm, and the thoracic cross-sectional area was reduced by a mean 32 cm2 at a level just above the diaphragm. No changes in the lung tissue were seen on CT scanning. Gas exchange, as assessed by multiple inert gas elimination technique and arterial blood gas analysis, was unaffected by restriction. It is concluded that in supine subjects, thoracoabdominal restriction that reduces FRC by 0.6 liter is not accompanied by atelectasis (normal CT scan). In this respect the result differs from that found in anesthetized supine subjects who show the same fall in FRC and atelectasis in dependent lung regions.

Abdomen↗
PubMed1988

Polyglycolic acid (Dexon) mesh graft for abdominal wound support in healing-compromised patients.

In 25 patients operated on for colorectal carcinoma via a paramedian incision, the anterior fascia of the rectus muscle was strengthened with a polyglycolic acid mesh graft. No adverse effects related to the mesh were detectable in these potentially contaminated patients, and none showed any sign of wound infection or wound herniation. The polyglycolic acid mesh graft thus can be successfully used as a support for abdominal wounds, especially in patients at elevated risk of infection or rupture of the wound.

Adult↗
PubMed1988

Effect of imipenem treatment versus imipenem surgical prophylaxis on the intestinal microflora.

The impact of imipenem treatment versus imipenem surgical prophylaxis on the intestinal microflora was investigated in 40 patients. Ten patients received 0.5 g imipenem four times a day and ten patients 1.0 g imipenem four times a day for four to 11 days for treatment of different infections. The imipenem treatment was associated with minor to moderate changes in the intestinal flora. There was a decrease in the numbers of enterobacteria, anaerobic cocci and bacteroides during treatment, but afterwards the microflora was normalized in all patients. No new colonization with imipenem-resistant bacteria was seen. No concentrations of imipenem in faeces were observed. Twenty patients undergoing elective colorectal surgery participated in the imipenem surgical prophylaxis group. To ten patients, imipenem was given in a dose of 0.5 g at induction of anaesthesia followed by subsequent doses of 0.5 g at 6 h intervals for 48 h. The other ten patients received 1 g imipenem at 6 h intervals for 48 h. The aerobic bacteria - staphylococci, streptococci, enterococci and enterobacteria - were suppressed significantly during the prophylaxis period. Among the anaerobic bacteria, cocci, bifidobacteria, eubacteria, lactobacilli, clostridia, fusobacteria and bacteroides decreased markedly during the same period. The microflora was normalized after two weeks. The imipenem concentrations in the intestinal mucosa varied between 0.1-3.6 mg/kg for the dose of 0.5 g and 3.2-13.4 mg/kg for the dose of 1.0 g, and the concentrations in the faecal samples were between 0.1-5.0 mg/kg and 0.7-11.3 mg/kg respectively.

Adolescent↗
PubMed1987

Lung collapse and gas exchange during general anesthesia: effects of spontaneous breathing, muscle paralysis, and positive end-expiratory pressure.

Lung densities (atelectasis) and pulmonary gas exchange were studied in 13 supine patients with no apparent lung disease, the former by transverse computerized tomography (CT) and the latter by a multiple inert gas elimination technique for assessment of the distribution of ventilation/perfusion ratios. In the awake state no patient had clear signs of atelectasis on the CT scan. Lung ventilation and perfusion were well matched in most of the patients. Three patients had shunts corresponding to 2-5% of cardiac output, and in one patient there was low perfusion of poorly ventilated regions. CT scans after 15 min of halothane anesthesia and mechanical ventilation showed densities in dependent lung regions in 11 patients. A shunt was present in all patients, ranging from 1% in two patients (unchanged from the awake state) to 17%. Ventilation of poorly perfused regions was noted in nine patients, ranging from 1-19% of total ventilation. The magnitude of the shunt significantly correlated to the size of dependent densities (r = 0.84, P less than 0.001). Five patients studied during spontaneous breathing under anesthesia displayed both densities in dependent regions and a shunt, although of fairly small magnitude (1.8% and 3.7%, respectively). Both the density area and the shunt increased after muscle paralysis. PEEP reduced the density area in all patients but did not consistently alter the shunt. It is concluded that the development of atelectasis in dependent lung regions is a major cause of gas exchange impairment during halothane anesthesia, during both spontaneous breathing and mechanical ventilation, and that PEEP diminishes the atelectasis, but not necessarily the shunt.

Adult↗
PubMed1987

Constitutional factors promoting development of atelectasis during anaesthesia.

The extent of atelectasis was correlated to constitutional factors in 38 patients who underwent computed tomography prior to and during general anaesthesia with halothane. All patients but two developed atelectasis in dependent regions of both lungs immediately after induction of anaesthesia prior to surgery. The transverse area of the densities ranged from 0 to 27 cm2, and there were no significant differences between patients of different age or sex, or with different smoking habits. A significant linear regression was found between Broca's index weight (kg)/height (cm)-100 and the area of the densities, and also between an index describing the shape of the thorax and the density area. Thus, patients who were overweight and/or had a low and wide thorax tended to develop more extensive atelectasis during anaesthesia. This finding might partly explain why overweight patients develop postoperative pulmonary complications more often than non-obese patients.

Adult↗
PubMed1987

Postoperative analgesia with intrapleural administration of bupivacaine-adrenaline.

Twenty-one patients who underwent elective cholecystectomy were studied with regard to the effect of intrapleural administration of bupivacaine-adrenaline solution on postoperative pain and ventilatory capacity. Administration of 10 or 20 ml of 2.5 mg/ml or 5 mg/ml bupivacaine solution resulted in complete analgesia in 143 of 159 administrations. Most patients experienced the maximal pain-relieving effect within 1-2 min and analgesia persisted as a rule for 3-5 h. Forced vital capacity and forced expiratory volume in 1 s increased after intrapleural analgesia on average by 56% and 46%, respectively, on the first postoperative day and by 35% and 51%, respectively, on the second day. There was no significant difference in the analgesic effect or in the effect on the ventilatory capacity between the 2.5 mg/ml or the 5 mg/ml solution, in either the 10 ml or the 20 ml dose. Placebo (NaCl) given intrapleurally had no effect on pain or on the ventilatory capacity. The plasma concentration of bupivacaine after intrapleural administration showed a wide interindividual variation, with considerably higher average values when the 5 mg/ml solution had been used than for the 2.5 mg/ml solution. Although no toxic effects were noted, a 2.5 mg/ml solution, which can be given in an initial dose of 20 ml and top-up doses of 10 ml at 3-6 h intervals, is recommended. In four patients minor pneumothorax developed when the catheter was introduced. The pneumothorax was easily evacuated, but underlines the need for great care when introducing the catheter.

Adult↗
PubMed1987

Computerized tomography of the chest and gas exchange measurements during ketamine anaesthesia.

The effects of atelectasis on pulmonary gas exchange were studied in eight supine, clinically lung-healthy patients. Atelectasis was studied by computerized tomography (CT), and gas exchange by blood gas analysis. The distribution of ventilation/perfusion ratios was assessed by a multiple inert gas elimination technique. No patient had any signs of atelectasis in the awake state, and gas exchange was normal. During ketamine anaesthesia and spontaneous breathing, lung ventilation and perfusion were well matched in most subjects. In one patient there was perfusion of poorly ventilated regions amounting to 14% of cardiac output, and in another there was a shunt of 4% of cardiac output; this patient was the only one who developed atelectasis in dependent lung regions. After muscular relaxation and commencement of mechanical ventilation, all patients but one developed both shunt (2-6% of cardiac output) and atelectasis. The shunt correlated to the size of atelectasis. It is concluded that the occurrence of shunt during anaesthesia is related to the development of atelectasis in dependent lung region, which is consistent with the hypothesis that it is changes in chest-wall mechanics that cause atelectasis.

Adult↗
PubMed1987

Psychiatric morbidity and personality characteristics of battered women.

Forty-nine battered women attending a surgical emergency department were studied with regard to prior and current psychiatric morbidity, substance abuse and personality characteristics, and were compared with a control group. More battered women than controls had consulted a psychiatrist and half of them were classified as heavy consumers of alcohol. One third of the assaulted women were found to be depressed, compared to 6% of the controls. The groups also differed in respect of muscular tension, aches and pain, and autonomic disturbances, the battered women having more pronounced symptoms. It is important for psychiatrists to recognize the symptoms that battered women often exhibit. With better early diagnosis, these women could be offered more appropriate psychosocial therapy.

Adolescent↗
PubMed1987

Battered women: a diagnostic and therapeutic dilemma.

A prospective study of women attending a surgical emergency department in an 8-month period showed that 117 (9%) had been battered. Offered in-patient treatment was accepted and completed by 58 women (the index group), while 59 declined or did not complete treatment (the drop-out group). Both groups were compared with age-matched controls. In the battered group there were more foreign-born women and more divorces than in the control group. The drop-out group differed from the index group either in being less severely injured and seeking only certification of injury for legal purposes, or in having more previous psychiatric morbidity. The consumption of somatic and psychiatric care during the preceding 10 years was significantly greater in the battered group than in the controls, probably due to the maltreatment and reluctance to report it spontaneously. Breaking of a battering pattern at an early stage requires awareness by surgeons, general practitioners and psychiatrists that recurrent injuries of unclear origin may be due to such violence.

Adolescent↗
PubMed1986

Hypertensive crisis immediately after complete removal of phaeochromocytoma.

A hypertensive crisis with an arterial blood pressure of 280/180 mmHg developed immediately after an apparently successful removal of a phaeochromocytoma. The blood pressure could not be lowered by phentolamine and not until the administration of dihydralazine and furosemide was the systemic pressure normalized. In addition to residual high concentrations of vasoactive substances, the hypertension may have been due to an overloaded vascular bed. Careful peroperative volume substitution in patients treated preoperatively with modern sympathetic blocking agents appears to be of great importance.

Adrenal Gland Neoplasms↗
PubMed1986

Atelectasis during anaesthesia and in the postoperative period.

Transverse sections of lung tissue were studied in patients by computerized tomography during anaesthesia and in the postoperative period. Eight patients were studied during intravenous (thiopentone) and six during inhalational (halothane) anaesthesia. The latter patients were studied during both spontaneous and mechanical ventilation. Five of the patients who underwent surgery for inguinal hernia and five patients in whom laparotomy was performed were studied 1 h and 24 h postoperatively. No patient showed any lung changes while awake preoperatively, and all patients developed dependent, crest-shaped lung densities within 5-10 min of anaesthesia. The densities comprised 3.4% of the lung volume in the caudal (basal) 5 cm of the lung tissue. No significant differences in the size and distribution of the densities were noted between spontaneous breathing and mechanical ventilation during anaesthesia, or between intravenous and inhalational anaesthesia. The densities remained in nine of ten patients 1 h postoperatively, and they remained in five of ten patients 24 h after anaesthesia. The densities are considered to be compression atelectases which may develop as a result of relaxation of the diaphragm. They may be important contributors to postoperative pulmonary complications.

Adult↗
PubMed1986

Correlation of gas exchange impairment to development of atelectasis during anaesthesia and muscle paralysis.

Pulmonary gas exchange and the development of atelectasis were studied in eight essentially lung-healthy patients, awake and during halothane anaesthesia with mechanical ventilation. Gas exchange was evaluated by a multiple inert-gas elimination technique and conventional blood-gas analysis, and atelectasis was studied by computerized tomography (CT). Ventilation and lung perfusion were well matched in the majority of the patients when awake. In two patients there was low perfusion of poorly ventilated regions (low VA/Q). One patient had a shunt corresponding to 4% of cardiac output. None of the patients showed signs of atelectasis on the CT scans. After 15 min of anaesthesia, shunt had appeared in all patients, ranging from 1% in two patients (unchanged from the awake state) to 17%. The major VA/Q mode was widened and ventilation of poorly perfused regions (high VA/Q) was noted in seven patients. Densities in dependent lung regions (interpreted as atelectasis) were seen on the CT scans in six patients. The extent of atelectasis was significantly correlated both to the magnitude of shunt (r = 0.93, P less than 0.01) and to the impairment of arterial oxygenation (r = 0.99, P less than 0.001). The findings indicate that atelectasis in dependent lung regions during halothane anaesthesia creates shunting of blood flow and that atelectasis is the major or sole cause of impaired gas exchange in the lung-healthy, anaesthetized subject.

Adult↗