Biomedical subjects
H Pedersen
Publications and source records attributed to H Pedersen.
Bupivacaine toxicity in pregnant and nonpregnant ewes.
The relative central nervous system and cardiovascular toxicity of bupivacaine was compared in pregnant and nonpregnant ewes during continuous infusion of bupivacaine into the jugular vein at the rate of 0.5 mg X kg-1 X min-1. In all animals, identical symptoms of toxicity occurred in the following order: convulsions, hypotension, respiratory arrest, and circulatory collapse. The dose of bupivacaine required to produce central nervous system (CNS) toxicity in the pregnant ewe tended to be lower than in the nonpregnant animal, although the difference was not statistically significant (P less than 0.1). However, the mean dose of bupivacaine resulting in cardiovascular collapse was significantly lower in pregnant ewes (5.1 +/- 0.7 mg/kg) than in nonpregnant animals (8.9 +/- 0.9 mg/kg). Similarly, bupivacaine blood concentrations at the onset of respiratory arrest and circulatory collapse were lower in the pregnant group, being 5.2 +/- 0.7 micrograms/ml and 5.5 +/- 0.8 micrograms/ml, respectively, versus 7.5 +/- 1.0 microgram/ml and 8.0 +/- 0.9 micrograms/ml, respectively, in the nonpregnant group (P less than 0.05). The concentration of bupivacaine in the brain of pregnant ewes at the time of cardiovascular collapse was significantly lower (P less than 0.01) than in the nonpregnant group (7.5 +/- 1.5 vs. 16.3 +/- 1.7 micrograms/g). The myocardial tissue concentration of bupivacaine also tended to be lower in the pregnant group, although the differences were not statistically significant (P less than 0.1).(ABSTRACT TRUNCATED AT 250 WORDS)
Cardiac disease in patients with reversible cerebral ischemic events.
The establishment of a possible association between ischemic cerebral attacks and prolapsing mitral valve has been studied in 45 consecutive patients aged 60 years or less with transient cerebral ischemic attacks and reversible ischemic neurological deficits. The study comprised cardiac history, auscultation, electrocardiography and echocardiography. We found only one patient (2%) with mitral valve prolapse but 19 patients (42%) with cardiac abnormalities. Two of the patients with cardiac abnormalities had a flail posterior mitral leaflet, one had ventricular septal defect and one had sclerotic aortic valves. We conclude that all patients with transient cerebral ischemic attacks should be subjected to heart examination, if possible including echocardiography.
Cisplatin in the treatment of advanced gastric carcinoma: a phase II study.
Twenty-one patients with advanced local or metastatic gastric carcinoma were treated with 75 mg/m2 of cisplatin every 3 weeks. Six patients had received no prior chemotherapy. One patient achieved complete tumor regression lasting 5 months, while three patients had partial responses of 2, 4, and 11 months' duration, respectively, resulting in an overall response rate of 18% (95% confidence limits: 5%-40%). All four responding patients had improvement in performance status. Two of six patients who had had no prior chemotherapy responded, while only two of 16 patients previously treated with 5-FU and doxorubicin responded.
[A combination of suppression and elucidation].
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A Gemeprost vaginal suppository for cervical priming prior to termination of first trimester pregnancy.
A randomized, double-blind, placebo-controlled, multicentre study was conducted to assess the efficacy and tolerance of a single 1.0 mg Gemeprost (16, 16-dimethyl-trans-delta 2PGE1 methyl ester) vaginal suppository for dilatation of the cervix uteri prior to vacuum aspiration termination of first trimester pregnancy in nulliparous women. The suppository was inserted three hours before vacuum aspiration. In the six centres involved, the preoperative cervical diameter was significantly greater in women treated with Gemeprost. Further mechanical dilatation was either unnecessary or significantly easier than in placebo-treated women. A significant reduction in operative blood loss was noted in the Gemeprost group.
CT findings in spastic cerebral palsy. Clinical, aetiological and prognostic aspects.
After the introduction of cranial computed tomography (CT) it is now possible by an atraumatic procedure to evaluate the pathophysiological findings in children suffering from cerebral palsy (CP). The aim of this study is to describe the cranial CT findings in children with CP and relate these to CP-type, grade of handicap, aetiology, and presence of other functional cerebral defects. The CT-examination was performed in 83 children with spastic CP (44 boys and 39 girls). Fifty-seven children (67%) had pathological CT. There was no statistically significant difference between the frequencies of pathological CT findings in the groups with tetraplegia, diplegia, and paraplegia. The frequency of pathological CT findings was increasing with increasing severity of the motor handicap (p less than 0.05). There were significantly more children with pathological CT findings among CP children suffering from epilepsy, than among CP children without epilepsy (p less than 0.05). The CP children with the lowest IQ, had numerical more pathological CT findings but there was no significant difference among pathological CT findings in CP children with oligophrenia compared to the rest of the group. Infarction, its sequelae and hemiatrophy were much more frequent in patients with hemiplegia (p less than 0.001) compared to the other CP-types. The most frequent pathological CT finding was atrophy (44 cases among 56 pathological CT). Central atrophy with enlargement of the ventricular system or parts of this was found in 39 children.(ABSTRACT TRUNCATED AT 250 WORDS)
Preserved prolactin fluctuations and response to metoclopramide in ovulatory, infertile, hyperprolactinemic women.
The study included 18 infertile, hyperprolactinemic women with preserved menstrual cycles. Among 13 women with consistently elevated prolactin (PRL) levels, 6 had either anovulatory cycles or luteal insufficiency, whereas 7 had apparently normal ovulatory cycles. Comparisons of these two groups showed that basal levels were similar but the PRL response to metoclopramide (MTC) and the day-to-day fluctuations were significantly lower in the group with altered ovulatory function. In this group the PRL response to MTC was significantly greater than in control patients with hyperprolactinemic amenorrhea (n = 12), but lower than in normal women (n = 10). The PRL response to MTC in hyperprolactinemic women with normal ovulatory function did not differ significantly from that of normal women, irrespective of whether hyperprolactinemia was sustained (n = 7) or intermittent (n = 5). The study indicates that the degree of autonomy of PRL secretion reflected by both the fluctuations in basal levels and the response to a dopamine antagonist, may be used to evaluate whether or not slightly elevated PRL levels are of clinical significance in relation to fertility.
Normal and abnormal prolactin levels during human pregnancy. Lack of influence on fetoplacental endocrine function.
Serial measurements of serum prolactin (PRL), chorionic gonadotropin (hCG), estradiol and progesterone were performed during 16 normal pregnancies. The same hormone analyses were performed in a woman with the galactorrhea-amenorrhea syndrome and a pituitary adenoma during two pregnancies, with and without continued treatment with bromocriptine throughout gestation. The study indicates that marked differences in circulating PRL levels do not influence the fetoplacental hormone levels. Furthermore, tumor expansion may possibly be prevented and successful breast-feeding can be achieved after treatment with bromocriptine throughout gestation.
Morphology of endometriosis before and during treatment with danazol.
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Administration of a retinoid as prophylaxis of recurrent non-invasive bladder tumors.
A controlled study has been conducted to ascertain whether administration for 8 months of a vitamin A-acid analog, Tigason, could prevent recurrences of non-invasive bladder tumors. Eligible were 73 patients, 33 in the Tigason group, and 40 in the placebo group. The results indicate that Tigason, as used in this study, is ineffective as prophylaxis. Side effects to Tigason urged 17 patients to drop out from the study mostly due to symptoms from skin and mucous membranes. The discussion considers different reasons for the lack of effect and concludes that more tolerable vitamin A-acid analogs are needed if further studies of prevention of non-invasive bladder tumors are to be carried out.
Surgical management of intestinal obstruction in the late course of malignant disease.
Intra-abdominal and pelvic malignancies not infrequently are complicated by intestinal obstruction during their progressive course. How energetically this complication should be treated is a matter of controversy. An analysis of 41 such cases is presented. Small-bowel obstruction was most commonly caused by extensive serosal carcinomatosis, whereas obstruction of the large bowel usually was due to a single tumor. There was good concordance between the preoperative assessment of blockage level (small v. large bowel) and peroperative findings. All the patients with colonic obstruction obtained palliation from surgery, with median duration 6 months. Only 63% of the patients with small-bowel obstruction were relieved. This figure fell to 44%, with median duration of relief only 2 months, when carcinomatosis was the causal condition. The corresponding figures for patients with block caused by a single tumor were 89% and 6 months. Intestinal obstruction from non-malignant mechanisms was relieved in all cases. Surgical exploration should be attempted in these patients, as conservative measures are known to be of little benefit. In patients with extensive carcinomatosis, however, a favorable outcome in terms of symptom relief and prolonged survival is relatively unlikely.
Regional anaesthesia in obstetrics.
This review includes a brief discussion of the indications and pitfalls of regional anaesthetic techniques commonly used during parturition. Emphasis is given to the physiological changes of pregnancy and the potential effects on the fetus. The criteria for the choice of local anaesthetic are also presented.
Hyperbaric bupivacaine for spinal anesthesia in cesarean section.
The efficacy and safety of 0.5% hyperbaric bupivacaine (Sensorcaine, Astra) was evaluated in 22 patients undergoing elective cesarean section under spinal anesthesia. The dose varied from 7.5 to 10 mg, (depending on the patient's height) which was significantly lower than previously reported. Patients were placed in head-down tilt immediately after subarachnoid injection. The mean spread of analgesia was to T3, which was reached in 10-15 min. Regression was complete in 258 +/- 16 min. Complete motor paralysis of lower extremities occurred in only two patients. Complete recovery of motor function in all patients was evident in less than 2.5 h. All infants were vigorous at birth and there were no serious maternal complications. The incidence of hypotension was 4.5%, the lowest reported as a consequence of spinal anesthesia in this group of patients. A technique involving the use of reduced doses of hyperbaric bupivacaine (0.5%) in conjunction with head-down tilt appears to be useful for spinal anesthesia for cesarean section.
[The contraceptive habits of women applying for termination of pregnancy].
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[Choice of termination of pregnancy. The significance of demographic and social factors].
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Etidocaine toxicity in the adult, newborn, and fetal sheep.
The systemic toxicity of etidocaine was compared in adult, newborn, and fetal sheep during continuous infusion of the drug into the jugular vein at the rate of 0.5 mg X kg-1 X min-1. All recipients exhibited symptoms of toxicity in the following order: convulsions, hypotension, respiratory arrest, and circulatory collapse. The dose of etidocaine required to produce CNS and cardiovascular toxicity was significantly different among the three age groups, being the highest in the fetus and the lowest in the adult. In contrast, no significant difference in etidocaine blood concentrations at the onset of each toxic symptom was observed among the groups except that convulsions and hypotension occurred at lower blood levels in the fetus as compared with the newborn and adult. Comparisons of etidocaine blood concentrations associated with the onset of convulsions and circulatory collapse (CC/CNS ratio) with those of lidocaine reported previously indicate that a narrower margin exists in adults and newborn following administration of etidocaine.
Prognostic value of in vitro measurements of platelet aggregability and fibrinolytic activity in patients with reversible cerebral ischemic attacks.
Platelet aggregability and fibrinolytic activity were studied repeatedly in 83 patients with reversible cerebral ischemic attacks over a median follow-up period of 26 months. Platelet hyperaggregability, defined as in vitro secondary aggregation obtained by adenosine diphosphate concentration less than or equal to 1 mumol/l, was demonstrated in 36.1% or the patients examined 5-8 days after the attack, but only in 6% of age- and sex-matched blood donors (p less than 0.001). Fibrinolytic activity was reduced in 57.8% of the patients, as compared with 20.5% of the controls. At the time of follow-up only 8% of the survivors showed platelet hyperaggregability, whereas the fibrinolytic activity was still reduced in 44.4%. Over the observation period 21.7% of the patients had a stroke or died. No significant correlation was found between abnormalities of platelet aggregability or of fibrinolytic activity, when observed 5-8 days after the ischemic episode, and the subsequent risk of stroke or death. It is concluded that in patients with recent cerebral ischemic attacks the demonstration of platelet hyperaggregability or reduced fibrinolytic activity appears to be without prognostic significance.