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Biomedical subjects

L Lindberg

Publications and source records attributed to L Lindberg.

At least 37 records · Page 2Linked to original sources
PubMed1997

A delivery system for inhalation of nitric oxide evaluated with chemiluminescence, electrochemical fuel cells, and capnography.

OBJECTIVE: To evaluate a system for delivery of inhaled nitric oxide. DESIGN: Prospective, laboratory study. SETTING: Engineering laboratory. SUBJECTS: A standard ventilator (Servo Ventilator 300), supplemented with extra gas modules for nitric oxide delivery. INTERVENTIONS: Two ventilator-integrated gas modules, delivering < or = 10 parts per million (ppm) or < or = 100 ppm of nitric oxide, were used in adult and neonatal modes during volume-controlled ventilation. Set nitric oxide concentration and FIO2 were systematically changed and compared with the measured concentration. Short-term mixing was tested in adult, pediatric, and neonatal modes by substituting nitric oxide with CO2, and measuring the delivered concentration by a fast-response CO2 analyzer during five successive respiratory cycles. Long-term mixing was tested with the administration of 25 ppm of nitric oxide for 7 days. MEASUREMENTS AND MAIN RESULTS: Delivered concentration of nitric oxide and nitrogen dioxide were simultaneously measured at the Y-place by two methods-chemiluminescence and electro-chemical fuel cells. The maximum absolute difference between set and measured concentrations of nitric oxide in the adult mode was 0.6 ppm at a set concentration of 10 ppm and 2.7 ppm at a set concentration of 100 ppm. In the neonatal mode, the maximal difference was 3.1 ppm at a set concentration of 100 ppm. Nitrogen dioxide concentration increased with increasing concentration of nitric oxide and oxygen to 2.6 ppm (as measured by the chemiluminescence analyzer) and 3.6 ppm (as measured by the electro-chemical fuel cell), at a setting of 100 ppm of nitric oxide with an FIO2 of 0.90 in the neonatal mode (2 L/min). During the short-term test of mixing stability throughout the respiratory cycles, a constant set CO2 concentration varied maximally by +/-6.2% from the set value in the neonatal mode, whereas the variance was by +/-6.5% in pediatric mode, and by +/-8.0% in the adult mode. During the long-term test, nitric oxide concentration varied maximally by +/-2.6% (as measured by the chemiluminescence analyzer) and by +/-2.3% (as measured by the electrochemical fuel cell). CONCLUSIONS: An accurate precision in delivered nitric oxide concentration was achieved during intermittent flow ventilation, and this accuracy was independent of tested ventilator settings. The delivery system administered an almost stable concentration throughout a respiratory cycle and during long-term delivery. If the mixing point is in the inspiratory part of the ventilator, valid measurement of nitric oxide and nitrogen dioxide delivery concentrations are possible. Both techniques for measuring nitric oxide and nitrogen dioxide have drawbacks.

Administration, Inhalation↗
PubMed1996

Effect of transforming growth factor-beta and platelet-derived growth factor-BB on articular cartilage in rats.

The short-term and long-term effects on the growth zone in articular cartilage of transforming growth factor-beta 1 and platelet-derived growth factor-BB injected intraarticularly into the knee joint of growing rats were investigated. The changes induced by five injections of 0.5 micrograms of transforming growth factor-beta 1 included a rapid decrease in the size and number of hypertrophic cells and an enhanced subchondral bone formation. The changes were most marked in the patella but were also apparent in the tibia and femur. The proliferating cells became swollen and lost their normal organization. From the seventh day of the experiment to about 3 weeks, the matrix stained intensely with safranin O for proteoglycans. The alterations induced by transforming growth factor-beta also included synovial fibroplasia and synovitis, consisting predominantly of mononuclear cells. Localised necroses in the cartilage sometimes appeared after 21 days. In long-term studies, destroyed cartilage was found in three of six rats and partial ossification of the joint cartilage was found in two after 90 and 180 days. Ossicles developed in the tendons in all six patellae. Injection of platelet-derived growth factor-BB resulted in an early and transitory minor increase in the osteogenic activity in the zone between cartilage and red bone marrow and later produced an ossicle in one of four tendons. None of the other changes noted after injection of transforming growth factor was observed.

Animals↗
PubMed1996

Inhalation of nitric oxide after lung transplantation.

BACKGROUND: Pulmonary hypertension is a postoperative complication that may adversely affect the outcome of lung transplantation. The effect of nitric oxide (NO) inhalation on pulmonary hemodynamic indices after lung transplantation was studied and compared with findings in control pigs. METHODS: Varying concentrations of NO were inhaled by 5 pigs after left lung transplantation and right pneumonectomy and by 5 controls after right pneumonectomy at an inspired oxygen fraction of 0.21 and 0.5. Hemodynamic data were recorded continuously, and fast circulatory courses were analyzed. RESULTS: Inhalation of NO reduced pulmonary vascular resistance and mean pulmonary arterial pressure in all pigs, but the decrease was pronounced and dose dependent only at an inspired oxygen fraction of 0.21 in the pigs that had transplantation. These were the only pigs that became hypoxic. With the termination of NO, there was a dose-independent rebound pulmonary vasoconstriction in the controls, especially at an inspired oxygen fraction of 0.21, but not in the pigs that had transplantation. This response was transient and could be blunted with a higher inspired oxygen fraction. CONCLUSION: Inhalation of NO reduced pulmonary vascular resistance in the transplanted lung and may be useful in the treatment of pulmonary hypertension after lung transplantation. The rebound pulmonary vasoconstriction with the termination of NO inhalation stresses the need to be aware of this effect and to wean NO carefully in clinical situations. This study showed oxygen dependency, which has to be taken into consideration in dose-response studies involving NO inhalation.

Administration, Inhalation↗
PubMed1996

Inhaled nitric oxide reveals and attenuates endothelial dysfunction after lung transplantation.

BACKGROUND: Maintaining endothelial function within transplanted organs may be critical to successful preservation. In this study we have evaluated the relationship between the effect of inhalation of nitric oxide and the degree of endothelial dysfunction after lung transplantation. METHODS: A left lung, which had been preserved for 24 hours, was transplanted and a right pneumonectomy was performed in 5 pigs. After a 24-hour observation period the pigs inhaled 5, 20, and 80 ppm nitric oxide, and pulmonary vascular resistance was recorded continuously. From the same donors preserved pulmonary arteries from the contralateral lung were studied simultaneously in organ baths. Acetylcholine chloride was used to elicit endothelium-dependent relaxation in vessel segments contracted with the thromboxane A2 analogue U-46619. RESULTS: Maximal endothelium-dependent relaxation decreased in the preserved lungs and correlated to the pulmonary vascular resistance in the simultaneously transplanted lungs. Inhalation of nitric oxide in the pigs that had received transplants caused the pulmonary vessels to dilate in proportion to the endothelial dysfunction. CONCLUSIONS: Preservation of lung for transplantation induces an endothelial dysfunction, and the degree of the decrease in pulmonary vascular resistance caused by nitric oxide inhalation may be an indication of the degree of this endothelial damage. The vasodilation caused by inhaled nitric oxide increases as the endothelial function deteriorates.

15-Hydroxy-11 alpha,9 alpha-(epoxymethano)prosta-5↗
PubMed1996

Influence of surrounding soft tissues on onlay bone graft incorporation.

OBJECTIVES: This investigation aimed to evaluate the influence of three different soft tissue environments on onlay bone graft incorporation into the craniomaxillofacial skeleton and to follow this process immunohistochemically by staining for some bone and cartilage matrix proteins and proteoglycans. STUDY DESIGN: Femoral and tibial bone grafts, either uni- or bicortical, were placed subperiosteally, submuscularly, and intramuscularly in 36 identically sized and aged isogeneic rats. The results were evaluated after 4, 12, and 20 weeks. RESULTS: Corticocancellous grafts showed a more extensive incorporation and more pronounced local resorption. Bicortical grafts produced more resorption of the recipient site, which oftentimes resulted in the graft being almost level with the surrounding bone. The marrow space of both graft types was sealed off by compact bone formation. Intense labeling of tested bone matrix proteins at various parts of the graft-host area was demonstrated. Ultimate graft height was significantly reduced for most groups, but no major differences between groups were registered. Intramuscularly positioned control grafts ultimately showed signs of lacking viability and reduced labeling of cartilage matrix proteins. CONCLUSIONS: These findings indicate that either type of graft had its drawbacks and that further studies to enhance integration and size maintenance are necessary to improve overall graft persistence. Immunolabeling may help to identify essential mechanisms in and find markers of graft incorporation.

Animals↗
PubMed1996

Strabismus in children with cerebral palsy.

In 48 children with cerebral palsy the characteristics of the squint and amblyopia were analyzed, also with respect to the features of cerebral palsy and to birth weight. Strabismus of congenital esotropia type was found to be common, as was also exotropia of early onset. Spontaneous alternation or an accommodative component of the squint was present only in a few cases. There was no evidence of an accumulation of any strabismus type in the different subgroups of cerebral palsy, whereas amblyopia or an obvious risk for amblyopia was found in the great majority of the cases. Some kind of amblyopia treatment was given to 34. Most of them showed improvement of the visual capacity which encourages treatment of amblyopia, even in children with cerebral palsy.

Adolescent↗
PubMed1996

Validation of nested Bordetella PCR in pertussis vaccine trial.

A nested PCR, using a 239-bp sequence in the pertussis toxin promoter region, was developed and evaluated. The assay differentiates Bordetella pertussis, Bordetella parapertussis, and Bordetella bronchiseptica by restriction enzyme analysis of the amplified fragments. The diagnostic performance of the PCR was evaluated in a Swedish pertussis vaccine efficacy trial which took place from 1992 to 1995, including study children and household members and using culture and serology for laboratory confirmation of suspected cases. In total 2,421 nasopharyngeal aspirates were analyzed. The total diagnostic sensitivity for B. pertussis was 90.2% (194 of 215). During the study period samples were processed with and without the cation-exchange resin Chelex. The PCR diagnostic sensitivity for B. pertussis among the Chelex-treated aspirates was 94.9% (75 of 79), and that for B. pertussis among 124 aspirates in a consecutive non-Chelex-treated material was 89.5% (111 of 124). After Chelex treatment of the 13 PCR-negative samples, an additional six became PCR positive, giving a final sensitivity of 94.3%. In addition, PCR was positive for B. pertussis with 57 of 1,744 samples negative by culture but with available serological data. The specificity of PCR with these samples was supported by a significant increase in antibody levels between acute and convalescent sera in 45 cases and by epidemiological or clinical data in all but two of the remaining cases. PCR was also positive for B. pertussis with 26 of 415 aspirates from episodes lacking serology. The diagnostic sensitivity of PCR for B. parapertussis was 74.0% (37 of 50). There were an additional seven culture-negative B. parapertussis PCR findings, six from cases with significant antibody increases against filamentous hemagglutinin only and one from a case lacking serology. There were no samples positive for B. bronchiseptica. In conclusion, PCR detection of B. pertussis and/or B. parapertussis enabled us to identify 90 positive nasopharyngeal aspirates, in addition to the 262 culture-positive samples (an increase of 34%). Relating these cases to serology and clinical data indicated a PCR specificity approaching 100%.

Adolescent↗
PubMed1996

Onlay bone graft behaviour after marrow exposure of the recipient rat skull bone.

This study aimed to evaluate the effects on incorporation of onlay grafts after exposure of the marrow of the skull recipient bed. Tibial or femoral uni- and bicortical bone grafts were positioned subperiosteally or submuscularly in the parietal and temporal region, respectively, of 28 adult rats. The recipient bed was ground to remove the external cortical layer and expose the underlying marrow. The outcome was assessed after four, 12, and 20 weeks by routine histology and immunohistochemical labelling for various bone and cartilage proteins. Marrow exposure resulted in an explosive bone formation, prompt graft incorporation, earlier onset of bone remodelling, but also localized resorption at the host bed due to increased vulnerability to pressure. Graft height loss was similar relative to previous observations by us using the same experimental model but without exposure of the marrow. The investigated proteins were identified at various locations and with different temporal sequences; the technique contributed to a diversified appreciation of graft behaviour. The findings emphasize the essential role of the bone marrow constituents to bone graft incorporation.

Animals↗
PubMed1994

Safe lung preservation for twenty-four hours with Perfadex.

The function of six porcine left lung allografts was studied after pulmonary (140 mL/kg) and bronchial (50 mL/kg) artery perfusion with Perfadex (Kabi Pharmacia, Uppsala, Sweden) at room temperature, followed by 24-hour storage of the lungs in an atelectatic state in 6 degrees to 8 degrees C Perfadex, which is a low-potassium-dextran solution. Left lung transplantation was done followed by right pneumonectomy, thereby making all the animals 100% dependent for their survival on the transplanted lungs. The pigs (mean weight = 56 kg, range = 51 to 58 kg, n = 18; 6 donors, 6 recipients, and 6 sham operated) were ventilated with a volume-controlled ventilator (20 breaths/min, 500 mL tidal volume, 8 cm H2O positive end-expiratory pressure, inspired oxygen fraction = 0.5). All the transplanted animals were in good condition throughout the 24-hour observation period with arterial oxygen tensions around 25 kPa (188 mm Hg) and arterial carbon dioxide tensions around 5 kPa (38 mm Hg). The mean pulmonary arterial pressure was around 30 mm Hg, and the pulmonary vascular resistance around 500 dyn.s.cm-5; neither showed any tendency to change with time. After 24 hours the inspired oxygen fraction was increased to 1.0 and the arterial oxygen tension increased to 43.3 +/- 5 kPa (325 +/- 38 mm Hg) (mean +/- standard error of the mean; n = 6). A sham operation (bilateral thoracotomy, right pneumonectomy) was done in 6 pigs, which were followed up for 24 hours.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1994

Efficacy of topical cooling in lung preservation: is a reappraisal due?

The aim of the present study was to test the efficacy of topical cooling as the only viable lung preservation method using the most challenging evaluation method, namely single-lung transplantation followed by immediate contralateral pneumonectomy. Ten domestic pigs (5 donors and 5 recipients) with a mean body weight of 57 kg (range, 53 to 59 kg) were used. After we administered systemic heparin (4 mg/kg), the lungs were harvested and placed in an atelectatic state under cold (8 degrees to 9 degrees C) low-potassium-dextran solution for 12 hours. Left lung transplantation was then done in the recipient pig followed by right pneumonectomy, thus making the recipient 100% dependent on the transplanted donor lung. No operative mortality or morbidity occurred. All animals were in excellent condition throughout the 24-hour observation period. They had normal blood gases which did not differ significantly from the preoperative blood gases obtained from the 5 recipients before transplantation (ie, when they had their own two lungs). A moderate increase (p < 0.05) in pulmonary vascular resistance was seen as compared with sham-operated animals. To conclude, topical cooling to 8 degrees C provides excellent lung preservation for 12 hours in pigs. If similar results can be obtained with other species, the currently accepted 6-hour limit for safe clinical lung preservation may be extended to 12 hours. It seems also warranted to critically reconsider which factors, apart from cooling alone, actually contribute favorably to 12-hour lung preservation.

Animals↗
PubMed1994

Nitric oxide gives maximal response after coronary artery bypass surgery.

The dose-response to inhalation of nitric oxide (NO) after coronary artery bypass surgery was studied in seven patients with normal preoperative lung function and chest radiograms. During postoperative controlled ventilation with PEEP 5 and 10 cmH2O, the patients inhaled NO in concentrations of 2 to 25 ppm, in random order, for 6 to 10 minutes. Hemodynamic and oximetric data were analyzed before, 5 minutes after start of the NO inhalation, and 5 minutes after the cessation. The response was the same at all concentrations; mean pulmonary artery pressure decreased by 11 +/- 1% (P < 0.05) and pulmonary vascular resistance decreased by 22 +/- 2% (P < 0.05). Systemic hemodynamics did not change, but oximetric parameters tended to improve. Changes in PEEP did not affect the response. It is concluded that, in patients who have undergone coronary artery bypass grafting, inhalation of 2 to 25 ppm NO causes a dose-independent decrease in pulmonary artery pressure and pulmonary vascular resistance. In order to investigate the dose-response curve, concentrations lower than 2 ppm of NO must be used.

Aged↗
PubMed1993

Sequential appearance of macromolecules in bone induction in the rat.

The appearance of noncollagenous proteins and proteoglycans during induction of cartilage and bone by implanted demineralized bone powder was studied by immunohistochemistry with polyclonal antibodies. Three bone proteins (osteopontin, sialoprotein, and a 62 kDa protein) were present in the bone powder grains before implantation. They appeared to be lost slowly from the granulation tissue but reappeared when bone formation started. The raw powder also contained a cartilage protein, biglycan (S1), chondrocalcin, cartilage oligomeric matrix protein, and the large proteoglycan aggrecan. The amounts of these molecules, however, increased significantly both within and outside the grains on cartilage formation. Cartilage matrix protein (148 kDa protein) appeared sparsely. The 58 kDa protein and fibromodulin (59 kDa protein), particularly the latter, were prevalent in fibrillar bundles. Antibodies against the laminin-staining vessel basement membranes showed an abundant occurrence of capillaries within the matrix grains in the granulation tissue and in the precartilaginous tissue. Bone powder made noninductive by 4 M guanidine HCl did not induce cartilage and did not stain for antibodies against bone proteins or for molecules restricted to cartilage.

Animals↗
PubMed1993

Safe pulmonary preservation for 12 hours with low-potassium-dextran solution.

The function of porcine left lung allografts was studied after perfusion with (150 mL/kg) and storage for 12 hours in a 4 degrees to 6 degrees C low-potassium-dextran solution (Perfadex; Kabi Pharmacia AB, Uppsala, Sweden). After a left lung transplantation, an artificial lung in the form of venoarterial extracorporeal membrane oxygenation was established. The artificial lung has a "biological" heparin-coated surface (Carmeda AB, Stockholm, Sweden), and there is no need for systemic anticoagulation. Immediately thereafter, pneumonectomy of the normal right lung was done. All the animals were weaned from the artificial lung within 1 hour after the pneumonectomy. Six animals were followed up for 24 hours. They were in good condition throughout the 24-hour observation period with arterial oxygen tensions around 200 mm Hg (inspired oxygen fraction = 0.4) and arterial carbon dioxide tensions around 40 mm Hg. This study demonstrates a reliable method for continuous evaluation of the function of a transplanted lung immediately after transplantation and over the ensuing postoperative period. Safe 12-hour lung preservation can be obtained with the low-potassium-dextran solution Perfadex.

Animals↗
PubMed1992

Familial pericentric inversion (3)(p12q24).

A large kindred with a familial pericentric inversion of chromosome 3, (p12q24), was found after an investigation initiated by a young female with three spontaneous first-trimester abortions. Altogether 22 (33%) inversion carriers were discovered, 9 females and 13 males. 6 women and 9 men were included in the fertility and segregation analyses because they were all either sexually mature or past maturity. The abortion frequency was below the average European rate in both the inversion carrier group and the cytogenetically normal relative group; 6%:3%, respectively. The mean numbers of pregnancies and live births (1.8-3.1) did not vary significantly in the two comparison groups. The segregation analysis among the inversion carriers showed a good correspondence to the theoretical 1:1 ratio (16:13). Males and females contributed equally. No duplication/deletion syndromes have been found in the kindred; all family members are phenotypically normal. We report a balanced familial pericentric inversion with no adverse effects. This chromosome aberration could be an example of a harmless chromosome polymorphism.

Abortion, Spontaneous↗
PubMed1992

Bedside chest radiography using digital luminescence. A comparison between digital radiographs reviewed on a personal computer and as hard-copies.

The introduction of picture and archiving communicating systems is currently being evaluated in several institutions. We decided, as an intermediate step, to see if image quality after transferral to a personal computer (PC) is sufficient for the diagnostic needs in an intensive care unit. Seventy-five portable digital chest radiographs were studied both as hard-copies and on a monitor after transferral to a PC. Two chest radiologists and one anesthesiologist reviewed the examinations. Our intention was to evaluate if everything that is routinely checked by the anesthesiologist is demonstrable after electronic transfer to a local workstation. We found practically no difference between the performance of monitor and film for the whole material.

Adolescent↗
PubMed1991

The release of gentamicin after total hip replacement using low or high viscosity bone cement. A prospective, randomized study.

Low viscosity bone cement is expected to give improved long term fixation of prosthetic components by increased intrusion into cancellous bone. Fixation is more difficult to achieve after revision for infection because of the inferior quality of the bone. We have compared the amount of gentamicin released from high viscosity and low viscosity bone cements in 41 patients undergoing total hip replacement. The concentration of gentamicin in serum and the wound secretion, and the amount recovered from the urine, was about three times higher for low viscosity cement. A possible explanation for this is an increase in surface area of the cement body because of improved intrusion of cement into bone. The improved mechanical fixation and the high concentration of gentamicin of the bone cement interface favours the use of low viscosity cement, especially in revision for deep infection.

Aged↗
PubMed1990

Effects of thiopental on resistance vessels in cat skeletal muscle.

Barbiturates are used clinically as anaesthetics and to reduce raised intracranial pressure. One side effect is hypotension, usually ascribed to a depression of cardiac contractility, while their effects on the resistance vessels are more controversial: both vasodilation and vasoconstriction have been described. This study analyzes the effects of thiopental on basal vascular tone in the cat skeletal muscle. We found that total resistance increased by almost 20% at low (50 mumol/l) and decreased down to about 50% of control at high (350 mumol/l) plasma concentrations of thiopental. The vasoconstriction dominated in the large arterioles (i.d. greater than 25 microns) and the vasodilation in the small arterioles (i.d. less than 25 microns). A dose-dependent inhibition of myogenic vascular reactivity (here defined as the maximum resistance increase to a transient rise in transmural pressure) coincided with the vasodilation. Autoregulation of blood flow was depressed by thiopental. During vasoconstriction there was a net transcapillary fluid absorption and during vasodilation a net fluid filtration. The fluid movements could be ascribed to variations in capillary hydrostatic pressure. If applicable to the cerebral circulation these results suggest that thiopental at high plasma concentrations might induce, instead of reduce, interstitial brain oedema.

Animals↗