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Biomedical subjects

M Bengtsson

Publications and source records attributed to M Bengtsson.

At least 91 records · Page 5Linked to original sources
PubMed1991

Viral haemorrhagic fever in Sweden: experiences from management of a case.

The first recognized case in Scandinavia with potential man to man transmission of viral haemorrhagic fever occurred in Linköping, Sweden, in January 1990. Following a visit to Kenya a 21-year-old male student suffered a very severe illness including extremely prolonged high grade fever, rash, disseminated intravascular coagulation with thrombocytopenia and severe bleedings. This necessitated one month of intensive care support including respirator treatment. The patient was discharged after 2 1/2 months in good condition, with a partial femoral nerve paresis. About 100 medical personnel were exposed to aerosol or blood before a strict containment regimen was established. No secondary cases occurred.

Adult↗
PubMed1990

On the identity of the xenobiotic-metabolizing form(s) of cytochrome P-450 in endocrine organs.

The adrenal cortex, the testes and the ovary metabolize polycyclic aromatic hydrocarbons (PAHs), e.g., 7,12-dimethylbenz[a]anthracene (DMBA). These activities have previously been shown to involve the cytochrome P-450 monooxygenase system [18-20]. In attempt to identify the form(s) of cytochrome P-450 involved, microsomes from these endocrine organs were subjected to SDS-gel electrophoresis, followed by immunochemical analysis using the Western blot technique. Antisera raised against the purified rat hepatic cytochrome P-450 isozymes a, b + e, c, d and PB-PCNE were tested. It was concluded that the electrophoretic mobilities of the immunoreactive bands obtained were not identical to the mobilities of the purified isozymes cytochromes P-450 a, b, c, d, e or PB-PCNE. These results indicate that the PAH-metabolizing monooxygenase(s) in these endocrine organs may involve a novel form(s) of cytochrome P-450.

Adrenal Cortex↗
PubMed1990

A new injection portal for brachially inserted central venous catheter. A multicenter study.

Totally implantable portal systems are widely used for long-term central venous access. A new venous portal system inserted via the brachial veins (P.A.S. Port system, Pharmacia Deltec Inc, U.S.A.) was studied in five centres. From January 1988 through May 1989 61 systems were implanted. Fifty-two patients had malignant diseases. Nine cases had non-malignant disorders. The portals were implanted subcutaneously in the fore-arm and catheterization was done percutaneously (46) or by cutdown-technique (15) under local anesthesia. Catheter tip position was controlled by fluoroscopy or x-ray. The basilic vein (49) and the cephalic vein (12) were used. The total follow-up time for all systems was 323 months. Forty-five systems were still in use at the end of the observation period, six were explanted electively at the end of infusion therapy and six systems were still functioning at the time of the patient's death (at a maximum of 14 months after implantation). Temporary armphlebitis was noticed on the first postoperative week in five patients. Two P.A.S. Port systems were explanted due to infection and one because of skin rupture at the wound. One intact system was removed as it was thought to be leaking because of needle displacement. The P.A.S. Port system is easy and safe to implant with a high success rate and a low complication rate. It is well accepted by patients and nurses. The device should be advantageous in patients unsuitable for standard venous portal systems and offers an excellent alternative system for venous access.

Adolescent↗
PubMed1990

Long term high dose morphine, ketamine and midazolam infusion in a child with burns.

The metabolism of morphine and ketamine was studied in a 14 month old child with extensive burns, who received infusions of both drugs for more than 30 days. The mean plasma clearance of morphine was 29 ml min-1 kg-1 and the plasma ratios of morphine-6-glucuronide to morphine were similar to those previously reported in children. The mean plasma clearance of ketamine was 32 ml min-1 kg-1 which is greater than that previously reported in older children and adults. There were no complications despite high dose long term therapy with morphine, ketamine and midazolam.

Burns↗
PubMed1990

Comparison of anaesthesia ventilators using a lung model.

The ventilatory performance of six anaesthesia ventilators (Alphavent Drägerwerk; MCM 801 Ventilator Dameca; Ohmeda 7000 Ventilator and Ohmeda 7800 Ventilator Ohmeda; Servo Ventilator 900 D and Ventilator 710 Siemens-Elema) was tested in a lung model and compared with the ventilatory performance of the old Engström 300 (Gambro Engström). The lung model consisted of one tracheal tube, two bronchial tubes which could be partially occluded, and two lungs (glass jars filled with water to a suitable compliance). Dialled (set) minute volume was compared to recorded minute volume. Gas distribution between obstructed and non-obstructed lung was calculated. All ventilators had a linear relationship between dialled and measured volume. Only the Servo Ventilator 900 D produced a gas distribution which was as good as, or better than that produced by the Engström 300.

Airway Obstruction↗
PubMed1990

Vagal and sympathetic activity during spinal analgesia.

Indices of vagal and sympathetic activity were studied in 30 elderly males, to elucidate their possible roles in causing hypotension during spinal analgesia. The technique of spinal analgesia and the regimen of intravenous fluids were standardised. An index of vagal activity was derived from the degree of heart rate variation (successive RR interval change) on ECG recordings. Sympathetic activity was evaluated by changes in the skin conductance (SCR) of 15 patients. Analgesia to pinprick reached a median dermatome level of T5-6 (range T2-T10) by 15 min. Hypotension was correlated with the level of analgesia, and was more likely when spinal analgesia was higher than T5. There was no correlation between vagal activity and the degree of hypotension. The depression of skin conductance responses was not correlated with the degree of hypotension nor with vagal activity. Vagal efferent activity, measured at the heart, does not seem to play a causative role in hypotension occurring during spinal analgesia.

Aged↗
PubMed1990

Cath-Finder Catheter Tracking System: a new device for positioning of central venous catheters. Early experience from implantation of brachial portal systems.

To simplify the implantation procedure of a new brachially implantable venous access system (P.A.S. Port. Pharmacia Deltec Inc., St. Paul, MN, USA), the Cath-Finder Catheter Tracking System (Pharmacia Deltec) was evaluated. The Cath-Finder senses the catheter tip position by utilizing a preconnected sensor wire (guidewire) within a catheter to detect an electromagnetic signal transmitted through the body tissue from a locator wand positioned over an appropriate external landmark. The aim of the study was to evaluate the accuracy of the Cath-Finder (compared to fluoroscopy) in determining the catheter tip position peroperatively during implantation of P.A.S. Port systems in patients with malignant diseases. The accuracy of the Cath-Finder in assessing the position of the catheter tip was registered in 16 implantation procedures. The tip positions determined with the Cath-Finder (when projected on the skin) correlated well to fluoroscopy (within 1 cm in eleven patients, 2-3 cm in four patients, and 4 cm in one patient). By using the right 3rd rib parasternally as an external landmark for the locator wand, the Cath-Finder Catheter Tracking System appears to be an alternative to fluoroscopy peroperatively for accurate placement of central venous catheters in the superior vena cava. However, a postoperative confirmatory x-ray control is recommended until further experience of the system is available.

Adolescent↗
PubMed1990

Nerve block in pancreatic pain.

Pain from pancreatic cancer is, in most cases, both severe and debilitating. Large doses of morphine are sometimes not tolerated or accepted by the patient, and are often ineffective. It has been claimed that "coeliac plexus block is the simplest, most effective and least hazardous" means of palliation (49, 59); we think that this is true, and that coeliac plexus block should be considered more often than it is today, and at an earlier stage. Only in rare cases should pain from pancreatitis be treated with a nerve block.

Abdominal Pain↗
PubMed1989

T-cell activation and subset patterns are altered in B-CLL and correlate with the stage of the disease.

Two-color FACS analysis was used to study activated and "functional" T and natural killer (NK) cell subsets of circulating lymphocytes in 23 patients with B-type chronic lymphocytic leukemia (B-CLL) and in 30 healthy subjects. As compared with controls, B-CLL patients had increased absolute numbers of phenotypically activated, HLA-DR+ CD4+ and CD8+ cells and T suppressor/effector (CD11b+CD8+) cells. When patients in Rai stages II through IV (n = 11) were compared with cases in Rai stages O through I (n = 12), the former group of patients had higher numbers of activated CD4+ and CD8+ T cells and decreased levels of suppressor/effector T cells. The absolute numbers of T suppressor/inducer (CD45R+CD4+) cells were elevated in patients with stage O through I disease but within normal range in stage II through IV leukemia. We further showed that the absolute numbers of NK-like (CD16+) cells and their activated counterparts (DR+CD16+) are elevated in B-CLL patients as compared with healthy subjects. The comparison of relative T and NK subsets in the blood of patients and controls showed that the proportions of CD4+, CD8+, and CD16+ cells expressing the activation marker HLA-DR were increased in B-CLL. Furthermore, the percentage of T-suppressor/inducer (CD45R+) cells within the CD4+ population was decreased in the patients. The proportion of T-suppressor/effector (CD11b+) cells within the CD8+ subset was reduced in subjects with stage II-IV disease only. When stimulated in vitro with the T-cell-dependent inducer TPA, B-CLL cells from patients in Rai stages II through IV secreted larger amounts of IgM as compared with cells from stage O through I patients. A positive correlation was observed between the degree of phenotypic activation of CD4+ T-helper cells and their functional capacity to augment IgM secretion by autologous B-CLL cells. Our findings indicate a tumor cell-directed regulatory role of T cells (and possibly NK cells as well) in B-CLL. Furthermore, monitoring of phenotypically activated and functional T-cell subsets may be helpful in the prediction of disease progression and timing of therapy in B-CLL.

Antigen-Presenting Cells↗
PubMed1989

[Upper airway obstruction and anesthesia--on warning signals illustrated by some cases reported to the Swedish Medical Responsibility Board].

Upper airway obstruction (e.g., epiglottitis, Ludwig's angina, or laryngeal tumour) can be a serious and life-threatening condition. The patient is asphyxiated, tired and prone to sudden apnoea and/or cardiovascular collapse. In using i.v. anaesthesia and muscle relaxation (e.g., by means of succinylcholine), the anaesthetist is taking a chance, and relying on being able to intubate the patient. Such an approach may lead to the patient's death, however, should the anaesthetist be unable to secure a free airway for artificial ventilation or to intubate the patient. Clinical symptoms are described as is the pathophysiology of upper airway obstruction. Preparatory intubation, while the patient is conscious, would seem to be the safest procedure to use in such cases.

Airway Obstruction↗
PubMed1989

Interleukin 4 strongly augments or inhibits DNA synthesis and differentiation of B-type chronic lymphocytic leukemia cells depending on the co-stimulatory activation and progression signals.

This study describes the opposing effects that interleukin (IL) 4 exerts on the B cell stimulatory factor (BSF-MP6) and IL 2-dependent proliferation and differentiation of cells of one selected B-type chronic lymphocytic leukemia cell clone (I83), which depend on the nature of the activation inducer. In I83 cells activated by a 1-h pulse of 12-O-tetradecanoylphorbol 13-acetate, the BSF-MP6-dependent DNA synthesis was strongly enhanced by 50-100 U/ml of recombinant IL 4. Recombinant IL 2 stimulation was necessary only when a suboptimal dose of BSF-MP6 was used. The differentiation was also markedly enhanced by IL 4 as measured by quantitation of IgM secretion both at the population (enzyme-linked immunosorbent assay analyses of the supernatant) and single-cell level (enzyme-linked immunospot technique), by morphological examination of the maturation stage and flow cytometric analysis of differentiation-associated surface antigens (CD11c, FMC7, PCA-1 and CD38). No Ig isotype switch was found. In contrast, DNA synthesis and differentiation of I83 cells, activated by Staphylococcus aureus Cowan strain I (SAC) and co-stimulated with BSF-MP6 plus IL 2, were strongly inhibited by IL 4, both when it was added simultaneously with SAC or after 2 days of SAC exposure. Analysis of the cell-cycle progression of SAC and BSF-MP6 plus IL 2 and IL 4-stimulated cells by acridine orange staining and fluorescence-activated cell sorter (FACS) analysis demonstrated an arrest of a minor cell population in G0 and a block of the transition of G1 cells to S phase. Neither the enhancing nor the inhibitory effect of IL 4 on the proliferation and differentiation of I83 cells was an indirect effect via IL 4-induced activation of contaminating T cells, monocytes or natural killer cells, as shown by experiments where these cell types were depleted by FACS sorting. Furthermore the expression of CD23 and CD25 was not inhibited by IL 4. The results thus demonstrate contrasting biological effects of IL 4 on clonal leukemic B cells depending on the nature of the activation and progression stimuli. This adds to the emerging picture of a very complex cytokine and cell-to-cell contact-mediated regulation of the activation and subsequent growth and/or differentiation of human B cells.

Antigens, Differentiation, B-Lymphocyte↗
PubMed1989

B lymphocyte regeneration in marrow and blood after autologous bone marrow transplantation: increased numbers of B cells carrying activation and progression markers.

The reconstitution of B cells in the bone marrow and peripheral blood was prospectively studied in 27 patients undergoing autologous bone marrow transplantation (ABMT). No major differences in B cell regeneration patterns were recorded between patients receiving marrows purged of B cells (anti-CD10 + 19; n = 17) and patients receiving unpurged marrows (n = 10). Compared with healthy controls, elevated absolute and relative numbers of B cells were recorded in the blood and marrow at +6 and +12 months in both groups of patients. CD23+ B cells were severely depressed during the first three months post ABMT, indicating immaturity. A twofold increase in B cells carrying the activation marker 4F2 was recorded in the marrow at +1 month. Serum immunoglobulin levels (IgG, IgA, IgM) were within low-normal range throughout the study. The depressed B cell responses reported after allogeneic and autologous BMT could in part be explained by the low expression of the CD23 antigen on B cells after such therapy.

Antigens, CD19↗
PubMed1989

Sympathetic blockade during extradural analgesia with mepivacaine or bupivacaine.

The extent of sympathetic blockade in 36 patients, who had been given extradural analgesia, was studied by means of the skin conductance response (SCR). The SCR was also studied in six healthy volunteers who received, in a cross-over fashion, infusions of physiological saline (placebo) and saline containing mepivacaine. Two more volunteers were given saline containing bupivacaine. Extradural analgesia caused a partial blockade of sympathetic activity. The higher the level of analgesia the greater the degree of inhibition of the SCR. Complete blockade of the SCR or only a weak response in the foot was obtained in the majority of cases when the level of analgesia reached a dermatome level of T4 or higher. There was no significant relationship between the degree of motor blockade of the lower extremities and the intensity of blockade of the SCR. Extradural injection of 2% mepivacaine had a greater effect on the SCR than did 0.5% bupivacaine. There was no indication that infusion of mepivacaine or bupivacaine in volunteers, whose blood levels were as high as or higher than those likely to be produced during extradural analgesia, affected the SCR.

Adult↗
PubMed1989

A modified method of curve analysis in foot volumetry and its reference values.

Foot volumetry was introduced by Norgren & Thulesius in 1973 as a non-invasive method of functional evaluation of venous insufficiency. In the following paper we suggest a slightly different method of curve analysis, thus showing the possibility of reducing the methodological error by 30-40%. Based on healthy men and women between 15 and 75 years, new reference values are presented.

Adolescent↗
PubMed1989

Treatment of pure red-cell aplasia and aplastic anaemia with ciclosporin: long-term clinical effects.

6 patients with pure red-cell aplasia were treated with Ciclosporin (Cyclosporine A; CS) alone or combined with prednisolone for a period of 9-46 (median 27) months. Prior to study, 5 cases had refractory disease, steroids were contraindicated in 1, and 4/6 patients, including 2 cases with congenital disease, had a disease duration exceeding 11 years. A complete haematological response was obtained in 5/6 subjects, and a partial response in 1. When the pre-treatment Hb levels (mean +/- S.D. = 64 +/- 13 g/l, range 41-80) for all 6 PRCA patients were compared with the Hb levels after 6 months of CS therapy (104 +/- 17 g/l, 80-125), a significant improvement was registered (p less than 0.005). In half of the patients, remission is maintained with CS as single drug in a dose-dependent manner. We also treated 5 patients with refractory severe aplastic anaemia with CS (1 case) or CS plus prednisolone (4 cases) for 3-27 (median 10) months. Only 1 patient responded. In this case, a complete haematological remission was induced with CS alone, and remission has been maintained for 27 months. Side effects of CS therapy were common but were dose-dependent and reversible, with the exception of persistent nephrotoxicity in 1 patient with pure red-cell aplasia. Based on our present results and a survey of the literature, we conclude that CS therapy is effective and indicated in refractory pure red-cell aplasia. In severe aplastic anaemia resistant to conventional immunosuppression, the response rate is lower, but a small proportion (around 15%) of patients may benefit from CS therapy. Longer treatment periods may, however, be needed to evaluate the role of CS in aplastic anaemia.

Adult↗