A psychiatric-psychological investigation of patients who had survived circulatory arrest.
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Adult↗
Biomedical subjects
M Bengtsson
Publications and source records attributed to M Bengtsson.
Antibody formation during the development of acute graft-versus-host disease after small-bowel transplantation.
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Acute Disease↗
Virologic investigation of a case of suspected haemorrhagic fever.
After travelling in subSaharan Africa, an area known for sporadic cases of Marburg virus infection, a young Swedish man presented with a classical picture of severe viral haemorrhagic fever complicated by disseminated intravascular coagulation and septicaemia. Serum samples examined by electron microscopy revealed particles of a size compatible with filovirions. Indirect fluorescent antibody tests indicated transient seroconversion to Marburg virus. In lymphocyte transformation assays of cells isolated from the patient 11 months after the onset of acute disease, Marburg viral antigen was able to stimulate lymphocyte proliferation 3.9-fold; however, exhaustive attempts to isolate virus from acute phase blood cultured in vitro or in vivo from guinea pigs and monkeys failed. Data suggest that this patient may have been infected with a filovirus. This case demonstrates the difficulties that may occur in laboratory diagnosis of viral haemorrhagic fevers.
Adult↗
Two cases of cauda equina syndrome following spinal-epidural anesthesia.
BACKGROUND AND OBJECTIVES: Cauda equina syndrome (CES) is a well-known complication of spinal and epidural anesthesia. Previous reports have implicated lidocaine, chloroprocaine, and procaine in its etiology, but not bupivacaine. METHODS: A 63-year-old man underwent transurethral resection of the prostrate for which he received bupivacaine with glucose intrathecally. Postoperative, he had difficulty in urination and defecation, and magnetic resonance imaging revealed spinal stenosis at the L1-L2 level. The second patient was a 70-year-old woman who underwent hip replacement surgery using a combined spinal-epidural technique. Postoperative, after 42 hours, when the epidural infusion of bupivacaine was stopped, the patient had difficulty in urination and defecation. No anatomical abnormality was found on magnetic resonance imaging. RESULTS: The two patients developed cauda equina syndrome following bupivacaine with glucose injected spinally, and bupivacaine without glucose injected in a combined spinal-epidural technique. CONCLUSIONS: This case report describes two cases of CES following the use of bupivacaine. The first patient had spinal stenosis which could explain this complication; however the explanation for CES in the second patient is uncertain and consequently speculative. We have discussed the possible contributing factors but believe that the etiology of CES in the second patient remains unknown.
Aged↗
Volatiles from apple (Malus domestica) eliciting antennal responses in female codling moth Cydia pomonella (L.) (Lepidoptera: Tortricidae): effect of plant injury and sampling technique.
The antennal responses of codling moth females, Cydia pomonella, to volatiles from apple branches with green fruits were recorded by electroantennography coupled to gas chromatography. The antennae strongly responded to 4,8-dimethyl-1,3(E),7-nonatriene, linalool, beta-caryophyllene, (E)-beta-farnesene, germacrene D, (Z,E)-alpha-farnesene, (E,E)-alpha-farnesene and methyl salicylate. These compounds were all present in volatile collections on Porapak Q from both living and cut branches. Analysis by the solid phase microextraction technique (SPME) showed that the emission of some electrophysiologically active compounds increased after branches had been cut, especially 4,8-dimethyl-1,3(E),7-nonatriene, linalool and (E,E)-alpha-farnesene. The identification of apple volatiles eliciting antennal responses is the first step towards the identification of compounds mediating host-finding and oviposition in codling moth females.
Acyclic Monoterpenes↗
Totally implanted device for venous access. Experience in tumour patients.
A device for central venous access consisting of a subcutaneous injection portal (Port-A-Cath) connected to a silicone rubber catheter was implanted in 30 tumour patients. The system was used mainly for the administration of antineoplastic drugs. During the investigation period (18 months) the systems remained in function for a median time of 155 days (range 7-372 days). Drug injections were given to 22/30 patients on a median of 11 occasions (range 2-65). Continuous infusions were administered to 17/30 patients for a median time of 15 days (range 1-43). Routine flushing with heparinized saline was performed monthly. Ten patients died with the system still functioning. In another 18 cases the devices were working at the completion of the study. One catheter extravasated. Skin erosion at the site of the portal occurred in 2 cases, in one of which the system had to be extracted. Partial caval thrombosis developed around a catheter tip in one case. No system became occluded or infected. Overall patient acceptance was excellent.
Adolescent↗
Efficacy of stellate ganglion block: a clinical study with bupivacaine.
BACKGROUND AND OBJECTIVES: When administering stellate ganglion blocks (e.g., to pain patients), it may be essential to know whether the sympathetic block is complete. The aim of the present study was to study the efficacy of stellate ganglion blocks using different concentrations and volumes of local anesthetic and different sites of injection. METHODS: Fifty-four stellate ganglion blocks (cervicothoracic sympathetic blocks) were performed for relief of chronic pain in 30 patients, all with a pre-block palmar skin temperature 32 degrees C or lower. Bupivacaine in random combinations of concentration (high, 5 mg/ml; low, 2.5 mg/ml), volume (high, 15-20 ml; low, 5-10 ml), and site of injection (C6 or C7) was used. The efficacy of these combinations was assessed by registering the following changes in effector organ activity: (1) observed signs (e.g., Horner's syndrome: miosis, ptosis, enophthalmos, and reddening of the sclera) and (2) objective measurements of changes in skin temperature, skin blood flow (laser Doppler flowmetry), skin resistance response, and in skin resistance level. RESULTS: Only 15 of 54 blocks met four of the five criteria for an effective block: a Horner's syndrome in combination with an increased skin temperature (to > or = 34 degrees C), increased skin blood flow ( > or = 50%), and completely abolished skin resistance response on both the radial and the ulnar sides of the blocked hand. Only six of those 54 met all five criteria: they also had an increase ( > or = 13%) in skin resistance level on the radial and ulnar sides. Injection toward C7 instead of injection toward C6, and high concentration instead of low, seemed to be more advantageous, whereas volume seemed to be of less importance. A relationship between pre-block skin temperature and the rise in temperature during the block was found. CONCLUSIONS: It was difficult to achieve a block that met all five established criteria. When assessing the efficacy of a stellate ganglion block, it is essential to evaluate the effects on vasoconstrictor and sudomotor fibers.
Adult↗
Effects of epidural bupivacaine or mepivacaine on somatosensory evoked potentials and skin resistance responses.
OBJECTIVE: The main purpose of this study was to compare the depth of neural block in lumbar epidural analgesia using either 20 mg/ml mepivacaine or 5 mg/ml bupivacaine. METHODS: Sixteen healthy patients were randomly divided to receive blindly either 17.5 ml mepivacaine (median, 15-20) or 17.5 ml bupivacaine (median, 14-20) for lumbar epidural analgesia. Afferent block was assessed by somatosensory evoked potentials (SEPs) during electrical stimulation of cutaneous sensory nerves at the T10, L1, L4, and L5 dermatomes. Efferent block was assessed by skin resistance responses (SRRs) recorded from the hand (C6), T12-L1, and foot (L5). RESULTS: Upper level of analgesia (pin-prick, cold) was T4 (T1-11) in the mepivacaine group and T4-5 (T2-9) in the bupivacaine group. In the mepivacaine group, SEPs were abolished in seven of eight cases at the T10 stimulation level and in five of eight cases at the L1 level. In the bupivacaine group, SEPs were abolished in two of eight cases at the T10 level and in three of eight cases at the L1 level. At the L4 and L5 levels, SEPs were only slightly changed in both groups. In the mepivacaine group, SRRs were completely or almost completely blocked (0-35% of control values) in all of eight cases at both the T12-L1 level and in the foot. Corresponding values for bupivacaine were six of seven and five of eight, respectively. Skin resistance responses in the foot and hand were significantly (p less than 0.05) lower in cases with abolished SEPs at the T10 stimulation level compared with those cases with preserved (although reduced) SEPs. CONCLUSIONS: Twenty mg/ml mepivacaine produces a more complete neural block than 5 mg/ml bupivacaine. The responsiveness of the afferent and efferent limbs of the nervous system was blocked in a similar manner as was shown by depression of the SEPs and SRRs.
Adult↗
[Nursing service in Spain].
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Education, Nursing↗
Sensory, motor, and sympathetic block during epidural analgesia with 0.5% and 0.75% ropivacaine with and without epinephrine.
BACKGROUND AND OBJECTIVES: Ropivacaine is a new long-acting local anesthetic, with vasoconstrictive properties. The purpose of this randomized, double-blind study was to evaluate sensory, motor, and sympathetic block following epidural anesthesia, and the influence of the addition of epinephrine. METHODS: Forty-eight male patients, scheduled for transurethral surgery, received 20 mL of 0.5% or 0.75% ropivacaine with or without addition of epinephrine (5 micrograms/mL) epidurally. Sensory block was assessed by pinprick, motor block by a modified Bromage scale, and sympathetic block by skin resistance level, skin resistance response, skin temperature, and skin blood flow (laser Doppler flowmetry). RESULTS: Onset time for analgesia was short (Th10 blocked after median 5.3-6.7 minutes), and maximum segmental level was median Th 2-3 (range, Th5-C4). A tendency toward a dose-response relationship (duration of sensory block) was noted for the 0.75% solutions (median, 258-264 minutes at Th10) compared to the 0.5% solutions (median, 228-234 minutes at Th10). Only about half of the patients exhibited a complete motor block of the lower extremities with a longer duration with the 0.75% solutions. The majority of patients had a marked or complete sympathetic block in the lower limbs. Short-lasting, mild hypotension, responding well to ephedrine intravenously, was noted in 40%-70% of the patients. No serious adverse reactions were observed. CONCLUSIONS: Ropivacaine given epidurally provided adequate sensory anesthesia and motor block for transurethral surgery. Addition of epinephrine did not provide any significant prolongation of the sensory or motor block, nor any influence upon the sympathetic block.
Adult↗
Lack of peripheral analgesic effect of low-dose morphine during intravenous regional anesthesia.
OBJECTIVE: To determine whether 1 mg morphine injected intravenously in conjunction with prilocaine has any effect on postoperative pain and analgesic requirement during intravenous regional anesthesia. METHODS: This was a randomized, double-blind study that included 37 patients undergoing carpal tunnel operations of the hand under intravenous regional anesthesia. Either 1 ml of morphine or 1 ml of physiologic saline diluted to 5 ml with 5% glucose was injected into the isolated exsanguinated arm. This was followed by 3 mg/kg of 0.5% prilocaine (total volume, 30-50 ml). Pain was assessed at 30, 60, 90, and 120 minutes, and 8, 24, and 48 hours after the end of the operation using a linear visual analog scale (VAS). The total number of analgesic tablets consumed in the first 48 hours were also counted. RESULTS: No difference was found in the VAS pain scores between the groups at any of the time periods studied. The postoperative analgesic requirement was similar in both groups. CONCLUSION: The authors conclude that 1 mg morphine showed no effect on postoperative pain or analgesic requirements when given in conjunction with prilocaine during intravenous regional anesthesia.
Adult↗
Central venous catheter placement using electromagnetic position sensing: a clinical evaluation.
A critical step in placing a central venous catheter (CVC) is positioning the catheter tip in a location just outside the heart in the lower superior vena cava. The authors report the clinical evaluation of a new commercially available system that uses electromagnetic technology to sense the position of a catheter tip during CVC insertion. Fifty catheters were implanted using fluoroscopy to monitor system accuracy. The catheters were accurately placed (within 2.5 cm of the desired optimal position) in 46 of the 50 cases (92%). In two patients with abnormal chest geometry (short, barrel chests), catheter tip location was difficult to determine. In two other cases, procedural difficulties unrelated to the system (difficulty in external landmark determination and unclear fluoroscopic view of the optimal position) resulted in catheter placement outside the targeted range. The electromagnetic system provides an opportunity to eliminate "blind" CVC placement procedures and to reduce or omit perioperative fluoroscopy of x-ray during CVC insertion.
Adult↗