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Biomedical subjects

B Schildt

Publications and source records attributed to B Schildt.

At least 37 records · Page 2Linked to original sources
PubMed1983

Nutritional assessment and clinical course in 112 elective surgical patients.

Recent Swedish reference values in anthropometry and delayed hypersensitivity (DH) were applied in the nutritional assessment of 112 surgical patients. The presence of three or more subnormal variables indicating malnutrition was found in 28% of all patients, and in 52% of those with malignant disease. The anthropometric variables revealed deficits in fat stores and muscle in 26 and 6%, respectively. Plasma protein determinations indicated malnutrition in 6-49%. DH skin testing revealed a subnormal response in 17% of the patients. Ten of the 79 operated patients had postoperative complications. Malnutrition was found preoperatively in six of these. The malnourished patients had a 5.5 times higher complication rate compared to the well-nourished (p less than 0.01). Subnormal values in albumin, prealbumin or DH were associated with a statistically significantly increased complication rate. Regression analysis showed correlations between the anthropometric measurements and plasma protein levels. Furthermore, DH correlated with triceps skin fold, albumin, prealbumin and cholinesterase.

Adolescent↗
PubMed1982

Long term parenteral therapy by percutaneous tunneled silicone central venous catheter--a follow-up of 300 catheters.

We have developed a technique for the management of central venous catheters which incorporates percutaneous insertion and daily care for routine use in different wards. A follow-up of the first 300 catheters is presented. When intravenous therapy was planned for more than two weeks, a silicone rubber catheter was introduced percutaneously with a skin tunnel and the position of the tip in the lower superior vena cava checked by venous pressure measurement. The metal hub of the catheter was disinfected daily by heating with a modified soldering iron which has been proved to be effective by in vitro testing with different microorganisms. The external jugular vein was used in 164 cases (55 per cent) the internal jugular vein in 115 (38 per cent) and the remaining catheters were inserted by the subclavian or antecubital route. Correct positioning was obtained in 96 per cent and serious early or late complications were rare there being only one case of septicaemia in a total treatment period of 270 months. One patient developed a lung infarct, but no case of pneumothorax has been seen. The mean duration of the catheters was 27 days (range 1-239) and the common reasons for termination were cessation of need in 84 per cent, mechanical obstruction in 6 per cent and inadvertent removal in 6 per cent. The described method has proved to be safe and to function well on ordinary wards.

Journal Article↗
PubMed1982

Extradural and parenteral morphine: kinetics and effects in postoperative pain. A controlled clinical study.

In a controlled clinical study of 20 patients undergoing arthrotomy a single dose of morphine 0.05 mg kg-1 administered extradurally resulted in more pronounced and prolonged pain relief than morphine 0.1 mg kg-1 i.m. in the period immediately after operation. This difference was significant between 2 and 11 h after morphine administration. The maximum analgesic effect for nine patients in the extradural group was obtained about 2 h after injection. Two of 10 in the extradural group experienced urinary retention. Other side-effects were mild for both groups. Plasma concentrations of morphine were measured in five patients in each group. Four hours after administration, morphine was not detectable in plasma in any of the extradural group and in two of the i.m. group. Our study gives further support for the theory that extradural morphine acts on the spinal cord.

Adult↗
PubMed1982

Adverse effects of extradural and intrathecal opiates: report of a nationwide survey in Sweden.

The Swedish Society of Anaesthetists conducted a nationwide retrospective survey of clinical experience with extradural and intrathecal opiates. Special interest was focused on the frequency and type of ventilatory depression. The questionnaire was answered by 84 of 93 departments (90%). Up to May 1981 extradural morphine had been given to approximately 6000-9150 patients, extradural pethidine to 220-450 and intrathecal morphine to 90-150 patients. Ventilatory depression requiring treatment with naloxone was reported in 23 patients treated with extradural morphine (0.25-0.40%) and in six given intrathecal morphine (4-7%). In 22 patients the administration of extradural morphine was considered as a major contributory factor for the occurrence of ventilatory depression. Only two of these 22 patients experienced ventilatory depression later than 6 h after the last dose of opiates (S.C., i.m., i.v. or extradural). Patients aged 70 yr or more, those receiving thoracic extradural puncture and those with reduced ventilatory capacity seemed to be overrepresented.

Adult↗
PubMed1982

Urinary excretion of sulfur amino acids and sulfur metabolites in burned patients receiving parenteral nutrition.

The urinary excretion of sulfur-containing compounds was studied in 11 burned patients during the first 10 days after injury. They were all given carbohydrate and fat by parenteral nutrition. Two patients also received large amounts of amino acids including methionine, whereas five patients were given amino acids including moderate amounts of methionine and cysteine. A sustained high excretion of mercaptolactate occurred in most patients. The excretion was not influenced by the type of parenteral nutrition, but related to the area of burned skin. A normal excretion of methionine, cyst(e)ine, inorganic sulfate, taurine, mercaptoacetate, thiosulfate, and thiocyanate was found at the end of the observation period in patients without amino acid therapy. Increased amounts of inorganic sulfate and methionine were excreted in patients receiving high doses of methionine, whereas an increased cyst(e)ine and taurine excretion was the most prominent finding in patients receiving moderate amounts of methionine and cysteine. These results indicate that burned patients have an unimpaired ability to metabolize sulfur amino acids. Patients not receiving amino acids or receiving moderate amounts of cysteine and methionine showed a negative sulfur balance, whereas patients given high doses of methionine maintained sulfur balance at near-zero levels. However, since signs of hepatic dysfunction appeared in the latter group, parenteral nutrition with amino acid mixtures containing high amounts of methionine is not recommended during the catabolic phase for burned patients.

Adult↗
PubMed1982

Metabolic studies in severe burns. Clinical features, routine biochemical analyses, nitrogen balance and metabolic rate.

The effects of two isocaloric regimens for parenteral nutrition were compared on days 2 to 8 after severe burns in 16 patients. Energy expenditure, plasma catecholamines, biochemical variables and N-balance were measured. The 8 patients in group I, with mean burn size 55/25%, received fat and glucose, while the 8 in group II, mean burn size 60/40%, were given 24 g amino acid nitrogen daily in addition to the fat and glucose. The mean metabolic rate on days 2-8 after burning was 70 +/- 7 and 69 +/- 5 kcal/m2/h in groups I and II, respectively. The mean values for plasma noradrenaline in the same period were 8.35 +/- 0.89 and 7.9 +/- 0.77 nmol/l. The biochemical changes showed a pattern typical of burns. There were no intergroup differences except for urea, which was significantly higher in the group (II) receiving amino acids. The cumulative N-balance was markedly less negative 8 days after trauma (-24 g N +/- 8 g) in group II than in group I (-100 g N +/- 10 g). These results indicate that a high nitrogen intake, together with adequate energy supply, improves the N-balance significantly in the early post-burn period. The high-energy supply from fat and glucose did not seem to cause the patients additional stress.

Adolescent↗
PubMed1982

Experience of an active regimen in the treatment of massive upper gastrointestinal haemorrhage.

Three-hundred and ninety-five cases of massive upper gastrointestinal haemorrhage were treated in the Surgical and Anaesthesiological Departments of the University Hospital in Linköping over a 5-year period. The mortality was 13%, or 10% when oesophageal varicosities are excluded. Results of a consistent policy concerning surveillance, diagnostic measures, and different forms of therapy are described. From the surgeon's point of view, emphasis is laid on the importance of endoscopy as a means of decreasing the number of exploratory gastroduodenotomies and increasing the proportion of patients in whom surgery is directed against a known source of bleeding. This leads to an enhancement of surgical expediency.

Adult↗
PubMed1981

Physiological cortisol substitution of long-term steroid-treated patients undergoing major surgery.

In 22 patients undergoing elective surgery, adrenal function was assessed before and on the day of surgery. Patients receiving corticosteroid therapy but with a normal cortisol response to a corticotropin stimulation test (group II, n = 8) were not given hydrocortisone on the day of operation. Their cortisol concentration increased in a manner similar to patients (group I, n = 8) who had never had corticosteroid treatment. The plasma cortisol concentrations in these two groups were less than in subjects (group III), n = 6) with an impaired cortisol response to corticotropin stimulation, who were given hydrocortisone 25 mg at the induction of anaesthesia followed by a continuous infusion of hydrocortisone 100 mg during the next 24 h. There were no clinical signs of circulatory insufficiency in any group. The low-dose hydrocortisone therapy regimen is sufficient for substitution of adrenal function during surgery and in the early postoperative phase. It could lead to mild oversubstitution in patients with impaired adrenal insufficiency undergoing major surgery.

Adrenal Cortex Hormones↗
PubMed1981

Metabolic studies in multiple injured patients. Clinical features, routine chemical analyses and nitrogen balance.

The effect of three different isocaloric parenteral nutritional regimes has been investigated in the early postoperative period in 19 patients with severe multiple injuries. Clinical course, biochemical analyses and nitrogen balance were monitored. The first group received glucose and insulin (n = 7), the second group fat and glucose (n = 6) and the third group fat, glucose and 24 g aminoacid-nitrogen (n = 6). The clinical course was similar in the three groups and all patients survived. The biochemical changes showed a typical pattern for trauma and there were no differences between the groups except for urea, which was significantly higher in the group receiving amino acids. The cumulative nitrogen balance was markedly less negative one week after trauma (-45 g N +/- 8) in the group given amino acids, glucose and fat compared to those given isocaloric amounts of glucose (-84 g N +/- 12) or glucose and fat (-95 g N +/- 10). This improvement in nitrogen balance was probably mainly due to an increase in protein synthesis.

Adolescent↗
PubMed1980

Biochemical changes associated with severe trauma.

The effects of different intravenous nutritional regimens on a number of biochemical indices of nutritional status were studied during the 8-day period following severe trauma. The inclusion of large amounts of amino acids (high nitrogen (N) was shown to greatly improve N balance over an isocaloric regimen containing no amino acids (O g N). The concentration of serum albumin, transferrin, prealbumin, and retinol-binding protein all fell during the study period in both patient groups, whereas the serum concentrations of acute phase reactants and of ribonuclease increased in the two groups. The sum of plasma levels of branched-chain amino acids and the essential amino acids was increased to a greater extent in the high N group. These amino acid totals and the ratio of glycine/valine showed a significant correlation with N balance in this group. Despite the marked difference in N balance, 3-methylhistidine excretion was increased but equal in the two nutritional groups, suggesting an increased rate of muscle protein breakdown in both groups, which appears not to be influenced by amino acid nutrition. It is concluded that N balance can be significantly improved in the immediate posttrauma period by provision of amino acids together with energy substrates. None of the biochemical variables measured, with the exception of plasma levels of essential amino acids, reflected these marked differences in N balance.

Adult↗
PubMed1980

Plasma atropine concentrations determined by radioimmunoassay after single-dose i.v. and i.m. administration.

The plasma concentrations of atropine following i.v. or i.m. administration to surgical patients were determined by radioimmunoassay. When atropine sulphate 1 mg was given i.v. there was a rapid initial removal of the drug from the circulation in the first 10 min; thereafter the plasma concentration decreased more slowly. Atropine i.m. was rapidly absorbed with peak concentrations occurring at 30 min following injection. The plasma atropine concentration then decreased slowly, probably because of uptake of atropine by muscarinic cholinergic receptors. The chronotropic effect of atropine appeared to correspond to the concentration in plasma following i.m. administration. We conclude that i.m. atropine, as a premedication, should be given not later than 30 min before induction of anaesthesia.

Adolescent↗
PubMed1980

Influence of cardiopulmonary bypass on some host defence functions in man.

Four different functions of the immune defence were studied in six men undergoing open-heart surgery with cardiopulmonary bypass (CPB). Pre-operatively, a few hours after and three days after surgery the following tests were performed: (I) in vivo phagocytic and metabolic functions of the reticuloendothelial system (RES), (II) haemolytic activity of blood monocytes, (III) nitroblue tetrazolium (NBT) reduction by granulocytes, and (IV) bactericidal capacity of granulocytes. Compared to the pre-operative values, the RES functions were unchanged postoperatively, whereas there was a significant increase in the haemolytic activity of monocytes and in the NBT reduction of granulocytes. The capacity of the granulocytes to kill bacteria was normal a few hours after surgery, but significantly increased on day 3. No infectious complications occurred and all patients recovered uneventfully. These results suggest that, at the present time, open-heart surgery under CPB is accompanied by an increased activity of granulocytes and monocytes in the early postoperative period.

Adult↗