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Biomedical subjects

B Brismar

Publications and source records attributed to B Brismar.

At least 127 records · Page 7Linked to original sources
PubMed1982

Reduction of catheter-associated thrombosis in parenteral nutrition by intravenous heparin therapy.

A prospective trial was carried out to test the hypothesis that therapy with intravenous (IV) heparin sodium reduces the incidence of thrombotic complications related to the use of central venous catheters for parenteral nutrition. The patients studied were randomly allocated either to a group given heparin sodium, at a dosage of 5,000 IU/6 hr, or to a control group that received no heparin prophylaxis. The heparin group comprised 23 catheter periods (22 patients), and the control group 26 catheter periods (25 patients). In five of the 23 catheters in te heparin group and 14 of the 26 in the control group, catheter phlebography revealed thrombus formation in association with the catheter when this was removed. The results indicated that the use of IV heparin as prophylaxis against thrombosis reduced the risk of thrombus formation on the central venous catheter.

Adult↗
PubMed1982

The terrorist bomb explosion in Bologna, Italy, 1980: an analysis of the effects and injuries sustained.

In August 1980 a terrorist bomb attack was made on the central railway station of Bologna, Italy. Altogether 291 persons were injured, 73 of whom died at the scene. An analysis of the nature of the injuries and the mechanism by which they occurred showed that three types of bomb injuries could be distinguished: primary blast injuries (pulmonary injuries and flashburns), and secondary and tertiary injuries (concussions, lacerations, and fractures), the latter two types from flying debris set in motion by the blast wave or propulsion of the body. Chest X-ray should be included as a routine part of the examination of blast-injured patients on admission, since many of them develop respiratory insufficiency within 24 hours even when primary symptoms are mild. Because the secondary and tertiary effects of a bomb explosion often lead to multiple injuries, these patients require considerable therapeutic and medical care resources. By an evaluation of the degree of severity of the injuries with use of the AIS (Abbreviated Injury Scale) and ISS (Injury Severity Score) systems, the injurious effects of different types of disasters can be estimated and the findings can serve as a basis for future planning of disaster preparedness.

Adolescent↗
PubMed1982

Oxygen uptake, plasma catecholamines and cardiac output during neurolept-nitrous oxide and halothane anaesthesias.

Cardiac output, oxygen uptake and plasma catecholamines were studied in patients both awake and during anaesthesia prior to and during upper abdominal surgery. Two different forms of anaesthesia were used: neurolept-nitrous oxide (NLA) and halothane (HALO) anaesthesia. Oxygen uptake was determined by using a masspectrometer, and cardiac output was measured according to the Fick principle. Plasma catecholamines were analysed by high performance liquid chromatography. Cardiac output fell by 40% during NLA and by 30% during HALO. Concomitantly, the oxygen uptake fell by 40% and 35%, respectively. A linear relationship between cardiac output and oxygen uptake could be established both in the awake state and during anaesthesia, with no significant change in the slope or position of the regression line when anaesthesia was commenced. Ventricular filling pressures fell during both anaesthetic procedures. Adrenaline fell to half the plasma concentrations seen in normal subjects under resting conditions, while noradrenaline returned to normal from an initially 30-40% increased value. Surgery caused no significant changes in either cardiac output or oxygen uptake, whereas plasma adrenaline increased by 20 times and noradrenaline by 60-90%. The findings suggest that the reduced oxygen uptake during anaesthesia causes the fall in cardiac output rather than any cardiodepressant action of the anaesthetic. It is possible that the anaesthetic depresses whole-body metabolism by either blocking the effects of catecholamines or interfering with cellular metabolism.

Aged↗
PubMed1982

Battered women. A surgical problem.

In a retrospective study on 456 women hospitalized at the Departments of Surgery and Oto-rhinolaryngology of Huddinge Hospital for emergency injuries during the years 1978 and 1979, the injuries were found to have been caused by battering in 29%. The majority of the women had been physically abused by their husbands, fiancés or cohabitees. As women seldom seek social or psychiatric assistance for this problem spontaneously, it is an important task of the responsible accident surgeon both to detect battering as the cause of the injuries and to act as mediator in contacting a women's refuge or other social assistance agency.

Abdominal Injuries↗
PubMed1981

Prophylaxis against microbial colonization of venous catheters.

A total of 85 central venous catheterizations in 73 patients were subjected to a prospective study on prophylaxis against infectious complications. Bacterial growth was found in blood cultures in five cases (6 per cent) and in cultures from catheter tips in 23 cases (27 per cent). The most important route of infections was shown to be the catheter connection. Flaming of the connection when changing the giving set did not reduce the risk of catheter tip colonization. Catheter-related thrombosis was found in 33 of 73 phlebographs (45 per cent). There was a significant relationship (p less than 0.05) between thrombotic findings and positive catheter tip cultures. Reduction of the risk of thrombosis by anticoagulant therapy would therefore seem indicated as prophylaxis against bacterial complications.

Adolescent↗
PubMed1981

Diagnosis of thrombosis by catheter phlebography after prolonged central venous catheterization.

Sixty central venous catheterizations in 53 patients were prospectively studied with respect to phlebographic findings after prolonged parenteral nutrition. Phlebography was performed by a special technique on completion of the intravenous therapy. Under fluoroscopic control, the central venous catheter was slowly removed, while simultaneously contrast medium was continuously injected through it. Two types of thrombosis were demonstrated--sleeve thrombosis, on 25 occasions (42%), and mural veno-occlusive thrombosis, on five occasions (8%). On removal of the catheter the sleeve thrombosis peeled off the catheter and in several cases it was noticed that parts of the sleeve thrombus or the entire sleeve became detached and were carried away with the blood flow. Although the sleeve thrombus seldom gave rise to any symptoms, this type of thrombosis is of great importance in view of the risk of pulmonary embolism, especially in connection with removal of the catheter. With use of the described phlebographic technique thrombi of this type can be visualized.

Adolescent↗
PubMed1981

Neural crest tumour syndromes.

Cells eminating from the embryological neural crest can create different neoplasias, some of them endocrinological active and sometimes multiple (MEN or MEA). The relationship between these conditions and multiple neurofibromas is pointed out. Three cases of MEA which have been operated on at Huddinge Hospital are presented.

Adult↗
PubMed1980

Bacteriology and phlebography in catheterization for parenteral nutrition. A prospective study.

A total of 42 central venous catheterizations in 32 patients were subjected to a prospective study with respect to bacteriologic and thrombotic complications. Growth of bacteria was found in blood cultures in 3 cases (7%) and in cultures from catheter tips in 15 cases (36%). In 25 cases (59%) phlebography revealed partial or complete thrombosis of the central vein. In 7 cases phlebography could not be performed because of blockage of the catheter (5 cases) or thrombophlebitis (2 cases). There was no relationship between bacteriologic and thrombotic complications. The frequency of bacteraemia is in agreement with earlier observations whereas the frequency of catheter-related thrombosis is much higher. This might be due to the fact that phlebography was performed at the time of catheter removal. The presence of catheter-related thrombosis is potentially hazardous as a source of microembolism. Prophylactic anticoagulant therapy in long-term catheterizations for parenteral nutrition is therefore suggested.

Adolescent↗
PubMed1980

Respiratory distress syndrome--a result of disseminated intravascular coagulation (DIC) or of fluid overload.

In 14 patients with the respiratory distress syndrome it was demonstrated that this condition was caused by the administration of excessive volumes of fluid. In none of six patients examined post-mortem were any signs of thrombi or emboli observed in pulmonary vessels. Caution with the initial supply of fluids following major trauma and major surgery is recommended. By monitoring pulmonary arterial pressure, optimum volume replacement with 5% albumin solution for example can be achieved.

Adolescent↗
PubMed1978

Effects of stored and fresh blood transfusions on postoperative pulmonary function. A clinical study on patients following extracorporeal circulation in association with aortic valve surgery.

The effects on postoperative pulmonary function of fresh versus stored blood when priming the heart-lung machine were studied in 49 patients subjected to aortic valvular replacement. The onset of extracorporeal circulation was considered to mimic the conditions of massive blood transfusion. The patients receiving heparinized fresh blood required more oxygen in the respirator than those receiving stored blood, but still had a significantly lower arterial oxygen tension during the first and second postoperative days. The fresh blood patients also showed a tendency to require a larger amount of diuretics to maintain adequate urine output. Pre- and postoperative bleeding and changes in postoperative hematological variables did not differ in the two groups. The results imply that stored blood should be preferable when substituting blood losses.

Aortic Valve↗
PubMed1978

Leg blood flow and central circulation at varying blood volumes. An intra-operative study of nine patients undergoing a femoro-popliteal vein bypass graft.

Common femoral arterial and bypass blood flows, cardiac output, brachial arterial and central pressures were measured in nine patients undergoing a femoro-popliteal vein bypass graft for intermittent claudication. The measurements were performed during neuroleptanesthesia before the operation, after the operation before blood substitution and then after transfusions of 450,900 and 1350 ml of blood. The leg blood flows were measured before and during local vasodilatation induced by intra-arterial injection of bamethane (Vasculat). The bypass flow was only 55 ml/min before blood substitution but was increased to 215 ml/min after the blood transfusions. The corresponding values for the common femoral artery were 100 ml/min and 430 ml/min, respectively. The maximal flow in the bypass vein during vasodilatation with bamethane (Vasculat) was 145 ml/min before blood substitution and 270 ml/min after the transfusions. This implies that the flow response to vasodilatation was more pronounced before than after blood substitution. The leg blood flow increased proportionally more than cardiac output on blood substitution. It is concluded that leg blood flow is very sensitive to hypovolemia and can be increased considerably by adequate blood substitution. The flow response to local vasodilatation is proportionally higher during hypovolemia.

Adult↗
PubMed1978

Estimation of femoral arterial blood flow from femoral venous oxygen saturation.

In six patients in whom a femoro-popliteal vein bypass graft was performed for intermittent claudication, the relationship between the haemodynamic state of the leg and the femoral venous oxygen saturation before and after local vasodilatation was investigated. The study was undertaken with special reference to the known influence of hypovolaemia on the leg blood flow. It is concluded that a femoral venous oxygen saturation below 70%indicates that the leg blood flow is less than 200 ml/min and that the bypass flow is less than 100 ml/min and thus within a range in which the incidence of early thrombosis is high. Furthermore, an increase in femoral venous oxygen saturation of 10% or more on local vasodilatation indicates a state of hypovolaemia, necessitating further blood substitution.

Arteriosclerosis Obliterans↗
PubMed1977

Leg blood flow and central circulation at various blood volumes: a peroperative study of nine patients with varicose veins.

1. In a group of nine middle-aged patients undergoing varicose vein surgery, cardiac output, right atrial, pulmonary arterial and capillary pressures, and leg blood flow were measured after induction of general anaesthesia but before operation, and also during operation before and after blood substitution. 2. Under anaesthesia, the mean pre-operative blood flows in the superficial and common femoral arteries were 160 ml/min and 280 ml/min respectively. These flows are comparable with those obtained in other studies under similar conditions but lower than values obtained in conscious subjects. During the operation the leg blood flow decreased by 24%. As cardiac output remained unchanged, the fractional leg blood flow fell. After transfusion of 900 ml of blood the leg blood flow doubled. 3. It is concluded that anaesthesia, surgical trauma and variations in blood volume greatly influence the leg blood flow and that an adequate substitution of operative blood loss is of utmost importance to achieve an optimum peripheral circulation.

Adult↗
PubMed1977

The cardiovascular effects of neuroleptanaesthesia.

Oxygen uptake, cardiac output, stroke volume and arterial and central blood pressures were measured before and after induction of neuroleptanaesthesia in 27 subjects. Nine were elderly patients operated on for obliterative arteriosclerotic disease, and the other 18--nine elderly and nine younger patients--underwent operation for varicose veins. Cardiac output, stroke volume and systolic arterial blood pressure decreased significantly with a corresponding decrease in oxygen uptake. The changes were most pronounced in the patients with arteriosclerotic disease. The arterio-venous oxygen difference was unchanged in the arteriosclerotics and decreased in the other two groups. The central pressures remained unchanged in all groups. It is concluded that the cardiovascular changes induced by neuroleptanaesthesia are due to a decrease in oxygen uptake and not to myocardial depression.

Adult↗