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Biomedical subjects

H Lindberg

Publications and source records attributed to H Lindberg.

At least 37 records · Page 2Linked to original sources
PubMed1996

Release of soluble tumour necrosis factor alpha receptors during and after paediatric cardiopulmonary bypass. Correlation with haemodynamic and clinical variables.

The release of cytokines during cardiopulmonary bypass (CPB) may contribute to haemodynamic alternations encountered after open heart surgery. Regulatory mechanisms exist and include soluble cytokine receptors. We have measured blood levels of tumour necrosis factor (TNF) and its soluble receptor (TNFsr) during and after open heart surgery in children. Correlation analysis to haemodynamic and clinical variables was performed. Using immunoassays the authors registered a significant increase in plasma levels of TNFsr with peak levels 2 h post-operatively at a level of 1702 +/- 170 pg/ml. The concentration of TNFsr remained significantly elevated until 48 h postoperatively but TNF was not significantly elevated. An inverse correlation existed between peak TNFsr and mean arterial pressure (rho = -0.827, P < 0.05), between TNFsr and cardiac index (rho = -0.8, P < 0.05), between TNFsr and left ventricular stroke work index (rho = -0.983, P < 0.01), between TNFsr and weight (rho = -0.85, P < 0.05) and between TNFsr and body surface area (rho = -0.867, P < 0.05). The authors demonstrate that the smallest children experienced the highest TNFsr concentration post-operatively. Furthermore cardiac performance, expressed as cardiac index and left ventricular stroke work index, correlated inversely to peak TNFsr level post-operatively.

Cardiopulmonary Bypass↗
PubMed1996

Serum N-terminal proatrial natriuretic factor in children with congenital heart disease.

An objective and simple method of establishing and grading heart failure in children is needed. The N-terminal of the atrial natriuretic factor prohormone, called proANF, is stable in vitro, relatively easy to measure and has been demonstrated as a clinically useful marker of heart failure in adults. We measured proANF in 62 children with congenital heart disease and in 62 age-matched controls, in order to examine the relationship of proANF to different clinical and haemodynamic parameters. Echo Doppler cardiography was performed in all children, and 29 also underwent cardiac catheterization. The children were classified for volume and pressure load in each cardiac chamber, for shunt size and for signs of heart failure. In paediatric patients without cardiac or renal disease, median proANF was 384 pmol.l(-1). In children with congenital heart disease, median proANF was 904 (200-5320) pmol.l(-1) (P < 0.001). The three groups with the highest proANF levels were children with documented high atrial pressure (median proANF 1885 pmol.l(-1)), a large left to right shunt (median proANF 1565 pmol.l-(1)) and moderate or severe heart failure (median proANF 1305 pmol.l(-1)). Furthermore, the proANF level correlated negatively with age and glomerular filtration rate. We conclude that elevation of the proANF level is related to atrial pressures, heart failure and a high pulmonary to systemic flow ratio. These findings make proANF a potential new diagnostic tool in heart disease in children.

Adolescent↗
PubMed1996

Left ventricular rupture following external chest compression.

A case of a 62-year-old woman suffering an acute cardiac arrest during a court dispute is presented. Cardiopulmonary resuscitation was immediately started by bystanders. In hospital there were signs of intrathoracic bleeding. A left thoracotomy revealed a cardiac rupture of the left ventricle and a large pericardial tear. Intraoperative evaluation of the heart as well as postoperative enzyme levels and ECG did not indicate acute myocardial infarction. The rupture may therefore be traumatic. The cardiac rupture was sutured five hours after the initial resuscitation, and the patient discharged from the intensive care unit two days after the rupture without clinical signs of neurological injury. A precordial thump is advised before start of external chest compression. One beneficial effect may be that the ventricles empty and the risk of traumatic rupture during compression is reduced.

Cardiopulmonary Resuscitation↗
PubMed1996

Release of interleukin-8 and calprotectin during and after paediatric cardiopulmonary bypass with and without ultrafiltration.

Release of calprotectin and interleukin-8 (IL-8), changes in leukocyte counts and subsets and influence of extracorporeal ultrafiltration were evaluated during and after cardiopulmonary bypass (CPB) in 18 children undergoing open-heart surgery for congenital heart anomalies. Ultrafiltration was used in nine cases and nine were controls. Calprotectin concentration rose after start of CPB, peaking 48 hours postoperatively, with no significant intergroup difference. Positive correlation was found between duration of CPB and calprotectin (peak level and accumulated total). Circulating IL-8 was detected in all patients perioperatively, peaking at wound closure in the ultrafiltration group and at termination of bypass in the controls. CPB duration correlated significantly to peak level and accumulated total of IL-8. Seven of nine ultrafiltrate samples contained IL-8 at levels similar to the plasma concentration. Changes in white cell counts were mainly attributable to neutrophils. The two subgroups did not differ significantly in neutrophil counts. Neutropenia found after 10 minutes of CPB was replaced by neutrophilia, with maximal values postoperatively. Calprotectin and IL-8 thus were released into the circulation during CPB in children. Ultrafiltration did not affect the plasma concentrations of these substances, and only IL-8 was detected in the ultrafiltrate.

Calcium-Binding Proteins↗
PubMed1996

Depressed thyroid function following paediatric cardiopulmonary bypass: association with interleukin-6 release?

Cellular activation with release of cytokines such as interleukin-6 (IL-6) occurs during cardiopulmonary bypass. IL-6 regulates a number of physiologic processes, and a possible role of IL-6 was recently postulated in the pathogenesis of changes in serum thyroid hormone concentrations in patients with nonthyroidal illness. The perioperative concentrations of triiodothyronine (T3) and IL-6 were determined in ten children undergoing open-heart surgery. Significant fall in T3 concentration was found postoperatively, while IL-6 increased significantly, peaking 2 hours postoperatively. The total accumulated IL-6 level 2 hours postoperatively was correlated to postoperative T3 concentration. A significant inverse correlation was found between T3 levels 24 and 48 hours postoperatively and total accumulated IL-6, and also between the percentage decrease in T3 concentrations and total accumulated IL-6. IL-6 release thus correlated inversely to T3 levels after cardiopulmonary bypass.

Anesthesia, Intravenous↗
PubMed1996

Ultrafiltration after cardiopulmonary bypass in children: effects on hemodynamics, cytokines and complement.

OBJECTIVES: The purpose of the study was to evaluate the clinical and hemodynamic effect of intraoperative extracorporeal ultrafiltration (UF) and its potential in reducing the plasma concentration of circulating cytokines and complement activation products following open heart surgery in children. METHODS: Eighteen children with congenital heart disease were prospectively randomized into a control group (n = 9) and a group who underwent UF (n = 9). Serial plasma samples for measurements of circulating cytokines (interleukin 6 (IL-6), tumor necrosis factor alpha (TNF), and its soluble receptor (sTNF receptor)), and complement factors (C3 activation products (C3a and C3bc) and terminal complement complex (TCC)) were obtained before, during and up to 48 h after cardiopulmonary bypass (CPB). A pulmonary artery thermodilution catheter was introduced preoperatively for hemodynamic monitoring. RESULTS: Postoperative hemodynamics were similar in both groups. Plasma levels of IL-6, sTNF receptors, C3a, C3bc and TCC increased significantly perioperatively (P < 0.01) in both groups. TNF was detected transiently in 16 patients perioperatively and in 4 of the 9 ultrafiltrate samples in concentrations similar to the plasma levels. Complement activating products were not detected in the ultrafiltration samples except for small amounts of C3a in two cases. Compared to the control group the plasma levels of C3a, C3bc and TCC were unaffected by the ultrafiltration procedure. The level of IL-6 and sTNF receptors increased significantly after 15 min of UF but there was no significant difference between the two groups postoperatively. CONCLUSIONS: In this study no clinical or hemodynamic effect was registered after UF. TNF and C3a were occasionally detected in the ultrafiltrate but we were unable to demonstrate reduction of these or any of the other markers tested in the group subjected to ultrafiltration.

Cardiopulmonary Bypass↗
PubMed1995

Endogenous norepinephrine stimulates both alpha 1- and beta-adrenoceptors in myocardium from children with congenital heart defects.

Atrial tissue removed from the cannulation site prior to cardioplegia (n = 15), and ventricular tissue therapeutically excised from the outflow tract of the right ventricle, (RVOT) (n = 2) were examined with respect to adrenoceptor mediated inotropic effect in children with congenital heart defects (CHD). We used sequential reversal by adrenoceptor antagonists of the tyramine enhanced response to endogenous norepinephrine to quantify the role of the beta- and the alpha 1-adrenoceptors, respectively, in the intropic response. Atrial myocardium had an alpha 1-adrenoceptor mediated component of 14% (median) (range 0-44%) and a beta-adrenoceptor mediated component of 86% (median) (range 56-100%). The patients with the highest alpha 1-adrenoceptor mediated inotropic components, had right ventricular pressure loads in the systemic range. In one specimen from RVOT, the ventricular alpha 1-adrenoceptor component was estimated to be 22% of the total inotropic response, compared to 26% in the corresponding right atrium. In a ventricular specimen from another patient, we could not demonstrate any alpha 1-adrenoceptor mediated inotropic component in contrast to 13% in the right atrium. This patient, however, had infusion of the alpha-adrenoceptor antagonist phentolamine after the excision of atrial tissue, but before the excision of muscular tissue from RVOT. In myocardium of children with CHD we found evidence that endogenous norepinephrine stimulated alpha 1-adrenoceptors in addition to beta-adrenoceptors. The relative contributions from the two adrenoceptors to the inotropic response varied considerably, and may be related to the pressure load of the right ventricle. These observations may be relevant with respect both to pathophysiology and to choice of drug therapy.

Child↗
PubMed1995

Complement activation and release of tumour necrosis factor alpha, interleukin-2, interleukin-6 and soluble tumour necrosis factor and interleukin-2 receptors during and after cardiopulmonary bypass in children.

C3 activation products, terminal complement complex (TCC), and cytokines including interleukins 6 and 2 (IL-6, IL-2) and tumour necrosis factor-alpha (TNF), and the soluble IL-2 and TNF receptors were determined serially during and up to 48 h after open heart surgery in children. Significant increases were noted in soluble TNF and IL-2 receptor levels postoperatively (p < 0.05). No significant increase over preoperative levels was seen in the cytokines, except for IL-6 which was significantly increased postoperatively (p < 0.01), reaching a maximum 2 h postoperatively. C3 activation products and TCC levels increased significantly after weaning from cardiopulmonary bypass (p < 0.05). The IL-6 response lagged behind the complement activation. We found a significant correlation between duration of cardiopulmonary bypass and IL-6 levels 48 h postoperatively (r = 0.852, p < 0.05). We conclude that the concentration of complement activation products, IL-6 and the soluble TNF and IL-2 receptors are significantly increased after open heart surgery in children. The cytokine receptor response probably reflects some sort of regulatory mechanism.

Cardiopulmonary Bypass↗
PubMed1995

Activation of the fibrinolytic, coagulation and plasma kallikrein-kinin systems during and after open heart surgery in children.

Activation of the fibrinolytic, coagulation and plasma kallikrein-kinin systems may be responsible for some of the coagulation disorders and inflammatory sequelae seen after extracorporeal circulation. The activation pattern of these systems was studied in 10 children undergoing open heart surgery with extracorporeal circulation. Blood samples were drawn serially before, during and up to 48 h after surgery. The heparin injection induced a significant elevation of plasmin (PL) (p < 0.05) which stayed elevated during extracorporeal circulation. Antiplasmin (AP) values were reduced at wound closure, while the levels were significantly elevated 48 h postoperatively (p < 0.05). alpha 2-antiplasmin-plasmin (APP) increased significantly perioperatively peaking 10 min after the initiation of cardiopulmonary bypass (p < 0.05). The coagulation markers thrombin-antithrombin (TAT) and the prothrombin fragment F1 & 2 increased significantly, peaking at wound closure and at termination of bypass respectively (p < 0.05). Plasma kallikrein (KK) values increased significantly with subsequent decreased levels of prekallikrein (PKK) and kallikrein inhibitor (KKI) after heparin injection. The KK level stayed elevated during cardiopulmonary bypass (CPB). The proenzyme functional inhibition index (PFI index), defined as the sum of deviations from the control values for proenzyme and functional inhibition values of the coagulation, fibrinolytic and plasma kallikrein-kinin systems, correlated significantly to the duration of cardiopulmonary bypass (p < 0.05). We conclude that open heart surgery in children activates the fibrinolytic, coagulation and plasma kallikrein-kinin systems.

Antifibrinolytic Agents↗
PubMed1994

[Endarterectomy of left coronary arteries. An angiographic follow-up study].

From January 1989 to December 1993, 25 patients underwent endarterectomy on the left coronary artery system. Eight of the patients had concurrent endarterectomy of the right coronary artery. The operative mortality consisted of one high-risk patient who died from an intraoperative myocardial infarction. Two patients developed non-fatal perioperative infarction. The follow-up period averaged 27 months (range 4-58 months). At follow-up one patient was lost for evaluation owing to unexpected sudden death, no patients had experienced myocardial infarction, 17 patients (74%) were free of angina, two patients were in NYHA class I and four in NYHA class II. All patients showed an improvement in relation to their preoperative condition. Two asymptomatic patients refused recatheterization, while 21 patients had a control angiographic study. 25 of 34 grafts to endarterectomized vessels were open (patency 74%) compared with 41 of 45 grafts to non-endarterectomized arteries (patency 91%). We find the angiographic and functional results acceptable and they should be acknowledged with reference to patients with diffuse distal coronary artery disease, many of whom would otherwise be considered inoperable.

Adult↗
PubMed1994

[Tetralogy of Fallot. A 20-year material].

Surgical repair of tetralogy of Fallot may be a first stage palliation with secondary physiologic correction or repair as a primary procedure. The aim of palliation is to increase the pulmonary blood flow. Since 1981 we have used an interposition shunt between the subclavian and the pulmonary artery for this purpose. Repair comprises closure of the ventricular septal defect and relief of the pulmonary stenosis. A primary repair may be performed if the pulmonary arteries have reached a certain size. The size and function of the left ventricle must also be able to cope with the increased work load. During the last 20 years, 333 operative procedures have been performed in patients with tetralogy of Fallot. This material comprises 107 shunts and 226 repairs. The total mortality while in hospital was 6%. During the last period from 1990 until January 1993 the mortality in hospital was 3% after operative repair. There have been no mortality following palliative procedures during the same period.

Angiocardiography↗
PubMed1994

Functional characterization of an ex vivo preparation of atrial myocardium from children with congenital heart defects: sensitivity to tyramine and adrenoceptor antagonists.

Small pieces of atrial tissue removed from the cannulation site before cardioplegia were used to develop a method for studying adrenergic regulation of the myocardial contractile force in children operated on for congenital heart defects (CHD). We measured the development of the isometric force of contraction dT/dtmax (T'max). Reduction in basal contractility induced by the beta-adrenoceptor antagonist timolol indicated that the myocardium was about half-maximally stimulated by endogenous norepinephrine (NE), probably released from nerve endings by the electrical stimulation. The inotropic effect of endogenous NE could be further increased by tyramine (EC50 approximately 5 microM). A maximal concentration of tyramine increased T'max by a median of 62.5% above the basal level. Sequential blockade of the beta- and alpha 1-adrenoceptors after tyramine stimulation by timolol and prazosin, respectively, indicated that a near-maximal response to combined adrenoceptor stimulation by endogenous NE was mediated by both beta-adrenoceptors (median 77%) and alpha 1-adrenoceptors (median 23%). The basal level of endogenous NE may conceal inotropic effects by exogenous alpha-agonists added to this type of preparation. This preparation is suitable for studying adrenergic regulation by reversing the effects of endogenous NE.

Adolescent↗
PubMed1993

[Hypoplastic left heart syndrome. Present experiences and future possibilities].

The authors report experiences from Norwood's staged palliation for hypoplastic left heart syndrome performed in Philadelphia on Norwegian children. Although there is no universal agreement that these children should be operated at all, the Norwegian health authorities have decided that all expenses for transport, examination and treatment shall be covered by the National Health Insurance Scheme. Since 1987 a total of 21 children have been transported to USA for operation. Eight of these children have completed all the planned stages of the operative treatment. Two are waiting for stage 3. 11 children have died. The authors discuss how to proceed with regard to treatment of this complicated patient group in future.

Atrial Function, Left↗
PubMed1993

Mental health and psychosocial functioning in adolescents with congenital heart disease. A comparison between adolescents born with severe heart defect and atrial septal defect.

Twenty-six adolescents, aged 13-18 years, with severe congenital heart disease were matched for sex, age and living area with 26 adolescents with repaired atrial septal defect and regarded as physically fit. These two groups were compared according to somatic condition, psychopathology, psychosocial functioning and chronic family difficulties. A higher rate of psychiatric problems in the complex group, an association between psychosocial functioning and physical capacity, as well as an association between psychosocial functioning and chronic family difficulties were observed. These findings suggest that physical capacity is of crucial importance for mental health and functioning of adolescents with congenital heart disease. The association with chronic family difficulties also suggests that a comprehensive biopsychosocial approach is necessary in the treatment and rehabilitation of these patients.

Adolescent↗
PubMed1993

Surgical intervention following failed percutaneous coronary angioplasty.

Percutaneous transluminal coronary angioplasty (PTCA) was performed on 725 occasions at the National Hospital of Norway in 1981-1990. Acute surgical intervention was necessary within 24 hours after PTCA in 15 cases, on indications that included coronary artery dissection (8 cases) and acute thrombotic occlusion (5). Electrocardiographic signs of ischemia were present in 11 patients with anginal pain, while two had severe angina but normal electrocardiogram. Two patients had a non-ischemic indication for surgery. Despite surgery, ten of the 15 patients had acute myocardial infarction. One of the ten died. At follow-up nine of 12 patients were free from angina and three had recurrent symptoms.

Angioplasty, Balloon, Coronary↗
PubMed1993

Prevalence of coxarthrosis in former soccer players. 286 players compared with matched controls.

We compared the occurrence of coxarthrosis in 286 male former soccer players in Malmö with a mean age of 55 years with an age-matched control group. During the last decades about one fifth in both groups had been referred to hip radiography. Coxarthrosis occurred in 5.6 percent of the former soccer players and in 2.8 percent of the control group (P 0.04). Among the 71 élite soccer players the prevalence of coxarthrosis was 14 percent compared with 4.2 percent in age-matched controls and non-élite players. Elite soccer players apparently run an increased risk of developing coxarthrosis.

Adult↗
PubMed1993

Coxarthrosis in farmers.

Recent studies have suggested an excess of coxarthrosis (osteoarthrosis of the hip joint) among Swedish farmers. The prevalence of coxarthrosis in the city of Malmö has previously been studied by coincidental examination of the hip joints on colon roentgenograms. The present study estimates the prevalence of coxarthrosis in farmers by examining the hip joint on roentgenograms of the colon and urinary tract. Fifteen-thousand farmers and farm workers affiliated with the Swedish Farmers' Safety and Preventive Health Association and all farmers aged 40 years or older in the Swedish country of Ostergötland were questioned about previous roentgenographic examinations. Four hundred thirty-five colon examinations and 465 urograms were available and scrutinized by the same physician. Forty-five of 565 male farmers and farm workers, aged 40-64 years, were found to have roentgenographic signs of primary coxarthrosis, compared with ten of 1250 men in the corresponding age group in the urban population of Malmö. The difference represents a rate ratio of 12 with a 95% confidence interval of 6.7 to 21.4. There was no difference in the prevalence of coxarthrosis among the female farmers and women in the urban population. The result suggests a relationship between coxarthrosis and farm work in men.

Adult↗