Biomedical subjects
Publications and source records attributed to R Ekroth.
Thirty-eight patients with haemothorax or empyema, in whom conventional drainage treatment had proved ineffective were treated with streptokinase instillations. An increased yield of fluid was noted in all cases, up to 1300 ml after one instillation. Re-expansion of the lung was observed radiologically in 30 cases. No serious complications occurred. The method seems very useful and is recommended.
Condyloma acuminatum very seldom affects the urinary bladder, but if it does conservative treatment has been considered of little value and cystourethrectomy will eventually be required. A case with urethrovesical condyloma is presented, where repeated transurethral resections cured the patient.
The flow velocity in the middle cerebral artery was measured continuously with a noninvasive transcranial Doppler in 18 patients during coronary artery surgery. Neurolept anesthesia and alpha-static acid-base management were employed. The flow velocity data were expressed as a percent of the awake level. During intubation, there was a transient flow velocity increase, which was related to a concomitant increase in mean arterial pressure (r = 0.67, p less than 0.01). Prior to cardiopulmonary bypass, flow velocity had decreased to 52.4% +/- 3.0% (mean +/- SEM). At the onset of cardiopulmonary bypass, flow velocity values were transiently doubled. Flow velocity then reached a stable level of 63% to 65% during hypothermia (25 degrees C to 30 degrees C). The increase from 52.4% to 63% to 65% was related to the reduction in hematocrit (r = -0.62, p less than 0.02). With rewarming, flow velocity increased to 101% +/- 5.2%. Flow velocity was found to correlate with temperature during cardiopulmonary bypass (median rs = 0.84, range 0.61 to 0.99, p less than 0.0001). No positive correlation was found between mean arterial pressure (MAP) and flow velocity during cardiopulmonary bypass. Although no direct metabolic measurements were performed, it is concluded that these findings are compatible with a maintained cerebral blood flow/metabolic coupling during cardiopulmonary bypass.
Acute ischemic heart failure was induced in eight dogs by coronary embolization. Severe depression of the left ventricular (LV) performance was evidenced. At 15 min after the embolization procedure, dopamine was infused at a dosage sufficient to increase the maximum rate of LV pressure rise (LVdP/dtmax) by approximately 50%. The significant improvement in cardiac performance was obtained at unaltered myocardial oxygen consumption (MVo2). Dopamine infusion was concluded, and after a stabilization period 300 IU of insulin was injected. This was followed by the infusion of glucose and potassium to maintain levels. Insulin significantly improved the performance of the failing left ventricle at unaltered MVo2, but to a lesser extent than did dopamine. Additional dopamine infusion further significantly improved cardiac performance. The net effect of insulin and dopamine in combination as compared with dopamine alone was a significantly greater increase in stroke volume and cardiac output due to a more pronounced decrease in total peripheral resistance. Dopamine increased arterial concentrations and myocardial uptake of free fatty acids (FFA). The net metabolic effect of insulin and dopamine in combination as compared with dopamine alone was a shift in myocardial substrate uptake from FFA to carbohydrates.
Systemic glucose uptake was studied in 31 patients during 4 hr starting 1 hr after open heart surgery, using the hyperinsulinemic "clamp" technique at different plasma insulin levels and at a glucose concentration of 6 or 10 mmol/liter. Possible metabolic side effects related to the glucose uptake were studied by measurements of urinary catecholamine excretion, O2 consumption, CO2 production, and arterial PCO2. A peak systemic glucose uptake of 7.0 +/- 0.4 mg/kg body weight/min was found at a plasma insulin concentration of 3192 +/- 150 mU/liter and a blood glucose concentration of 10.2 +/- 0.1 mmol/liter. No significant difference was found in urinary catecholamine excretion compared to control patients. O2 consumption was unaltered while a 15% increase in CO2 production was observed.
The splanchnic balance of glucose was studied in the basal state and at three levels of "clamped" hyperinsulinemia (260 +/- 23, 510 +/- 59, 3875 +/- 367 mU/liter) in 24 patients (43-70 years of age), who had undergone coronary surgery about 1 hr previously. The splanchnic balance of glucose in the basal state was negative in all patients (-1.6 +/- 0.3 mg/kg/min) and was changed into a zero-balance within 30 min when 0.15 or 0.3 U/kg/hr of insulin was infused. At an insulin infusion rate of 1.0 U/kg/hr the net splanchnic glucose balance was turned into a significant positive balance of an average 0.9 +/- 0.3 mg/kg/min.
In this study, 28 patients with maintained beta-blockade underwent coronary artery bypass grafting. Twelve of these patients, who received preoperative infusion of carbohydrate-phosphate solution, had a smaller cumulated leakage of CK-B compared to the others, suggesting reduced myocardial damage.