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Biomedical subjects

S Lennquist

Publications and source records attributed to S Lennquist.

At least 73 records · Page 4Linked to original sources
PubMed1984

Intestinal intramural haemorrhage after abdominal missile trauma--clinical classification and prognosis.

Various types of abdominal trauma, such as penetrating missile wounds, blast and severe blunt force, can cause haemorrhage within the intestinal wall. Such bleeding often is multi-sited. In a previous study on anaesthetized pigs subjected to missile trauma, the microscopic appearance of the lesions was described. Risk of perforation, even in lesions of primarily innocent appearance, was also demonstrated, in accordance with reports in the literature. The present study aimed to find a method for predicting which of such haemorrhages may be left untreated and which must be excised. For this purpose, 85 anaesthetized pigs were subjected to low-velocity missile injury to the abdomen. All intramural haemorrhages of the intestine without primary perforation was thereafter classified at laparotomy according to a few easily observed macroscopic criteria. The anaesthesia was maintained and the classification was compared with findings at a second laparatomy at the end of the observation period (maximum 4 days), when histologic study also was performed. The macroscopic criteria showed good correspondence with histologically observed mucosal ulceration and muscle damage. In 64% of the lesions there was macroscopic progression during the observation time, with perforation in 5.4%. Lesions with mean diameter larger than 10 mm, visible serosal defect and palpable mural defect carried the highest perforation risk (16%). Lesions fulfilling none of these criteria did not perforate. The study confirmed the risk of secondary intestinal perforation in primarily non-perforating intramural haemorrhage following abdominal trauma. The results also suggest that some simple macroscopic criteria may be useful for predicting this risk.

Abdominal Injuries↗
PubMed1984

Fluorescein angiography in the evaluation of intestinal intramural haemorrhage after trauma.

Intramural hemorrhage of the intestines occur after different types of abdominal trauma. These haemorrhages may lead to secondary perforation and peritonitis. As the bleeding often is multifocal, radical resections would entail correspondingly many anastomoses, with increased risk of complications. A method for macroscopic recognition of perforation risk was described in a previous report. The macroscopic criteria used in that classification have now been compared with a vital staining technique, involving intravenous injection of fluorescein. The fluorescence patterns of 'non-viability' accorded well with histologically observed damage to the muscular layer of the gut and with transmural devitalization. There was also good correlation with the macroscopic criteria in the previous classification, but the fluorescein method was higher predictive of transmural devitalization. When the methods were combined, the detection of dangerous lesions was still improved. Fluorescein staining is clinically applicable, and thus can be a valuable complement for discerning heightened risk of perforation in intestinal intramural haemorrhages.

Abdominal Injuries↗
PubMed1984

Intestinal intramural haemorrhage after blunt abdominal trauma.

Intramural haemorrhage of the intestine following blunt trauma to the abdomen has been described in several clinical studies. Though such lesions may have an innocent appearance at primary laparotomy, they lead to delayed intestinal perforation in some cases. In previous experiments with similar lesions produced by penetrating abdominal missile, the histologic appearance and the clinical course were documented in pigs observed under long-term anaesthesia. In the present study anaesthetized pigs were submitted to blunt abdominal trauma in an impact machine, whereby the impact velocity could be regulated. The intra-abdominal pressure and the delivered impulse were recorded and the incidence and histologic appearance of intestinal injuries were observed at laparotomy immediately after the trauma. Intramural haemorrhage was found to occur when the impact velocity exceeded 5 m/s. At impact velocity 20 m/s, intestinal rupture occurred primarily. The observed intramural haemorrhages had the same histologic appearance as those seen after penetrating missile injury. The same clinical course, consequently, could be anticipated after blunt trauma.

Abdominal Injuries↗
PubMed1984

Intra-operative irrigation of the peritoneal cavity with ampicillin in experimental posttraumatic peritonitis.

Penetrating abdominal wounds with injury to the intestines were inflicted on 24 anaesthetized pigs. The injured gut was resected. During this operation the peritoneal cavity in 9 pigs was irrigated with 3 litres of antibiotic solution (ampicillin 2 g/l). In 15 pigs the irrigation was done with 3 litres of saline solution only. During the postoperative observation period the animals were in continuous anaesthesia. Absorption of ampicillin, reduction of the peritoneal bacterial flora and emergence of resistant strains were evaluated. Ampicillin was rapidly absorbed to the systemic circulation, with an average peak concentration of 42.4 +/- 1.7 mg/l. The average half-life of the drug in serum was 54 +/- 4 min. The average density of the total aerobic flora decreased during the operation from 10(4.74) CFU/ml peritoneal exudate fo 10(1.20) CFU/ml, but increased to 10(5.16) CFU/ml during the posttraumatic observation period. Total anaerobic counts changed to similar extent. The results were not significantly different from the values in the saline-irrigation group. Ampicillin irrigation led to a significant increase of resistant strains, from 25% before irrigation to 97% at the end of the observation period.

Abdominal Injuries↗
PubMed1983

Posttraumatic hypophosphataemia and urinary phosphate excretion with and without phosphate supplementation. An experimental study in pigs.

Hypophosphataemia commonly follows trauma of various types. Several aetiologic factors have been proposed and the clinical significance of posttraumatic hypophosphataemia has been discussed. For study of the mechanisms underlying hypophosphataemia associated with surgical trauma, an experimental model has been developed which permits induction of hypophosphataemia under standardized conditions in anaesthetized and traumatized pigs. In the present study this model was used to investigate the relationship between posttraumatic hypophosphataemia and urinary excretion of with or without phosphate supplementation. The results suggest that the adrenaline release associated with stress and trauma induced an immediate and rapid fall in the serum phosphate (S-P) level. The abrupt fall was followed after 24 hours by a slower decrease. This second phase of S-P decrease was not induced by catecholamine release or by glucose infusion and was not prevented by phosphate supplementation. It appeared to be related to an inadequate renal response to the hypophosphataemia, i.e. a relative phosphaturia. The cause of this phosphaturia is not fully understood, but both extracellular volume expansion and the humoral response to trauma are possible explanations.

Animals↗
PubMed1983

Intra-operative saline irrigation of the peritoneal cavity in experimental post-traumatic peritonitis.

A trial of intra-operative saline irrigation of the peritoneal cavity for the prevention of peritonitis was conducted in an animal model. Following abdominal missile injury with intestinal perforation, 43 anaesthetized pigs were operated on an randomly assigned to three treatment groups. In two of the groups intraperitoneal irrigation with 3 litres of saline solution was performed during the operation, using a jet technique in one group. A control group of pigs received no irrigation. The effect of irrigation was evaluated with quantitative bacteriologic studies of peritoneal exudate and peritoneal biopsy specimens. Continuous anaesthesia and assisted ventilation were used and the post-trauma observation period was 3 days. The average bacterial density in the peritoneal exudate decreased by more than 99% in all treatment groups during the operation, but increased to more than the pre-irrigation level during the observation period. Irrigation did not result in significantly greater elimination of the bacterial population. The mortality was not lower in irrigated animals than in the controls. Intra-operative saline irrigation thus did not prevent peritonitis in this experimental model.

Animals↗
PubMed1983

Muscular high-energy phosphates and red-cell 2,3-DPG in post-traumatic hypophosphataemia. An experimental study in pigs.

The relationship between post-traumatic hypophosphataemia, muscular high-energy phosphates (HEP) and red-cell 2,3-diphosphoglycerate (2,3-DPG) were studied in an experimental trauma model. Twenty-three anaesthetized pigs were submitted to trauma and observed for 72 hours. In group I (n = 10) and group II (n = 6) major trauma was inflicted with a high-energy missile. No phosphate supplement was given in group I, but group II pigs received 20 mmol phosphate/24 hours parenterally. Group III (n = 7) sustained only minor trauma, consisting of tracheotomy and catheterization of artery, vein and bladder, and received no phosphate in the post-trauma observation period. Reduction of serum phosphate was found in all groups after trauma. In skeletal muscle, decreased levels of HEP were observed after major trauma, whether or not phosphate supplement was given. Following minor trauma there was no alteration of muscle HEP. In red-cells, 2,3-DPG decreased slightly only after major trauma in pigs without phosphate supplement. Conclusions from the study were that hypophosphataemia was associated with cellular metabolic disturbance only after major trauma. In red-cells this disturbance seemed to be prevented by administration of phosphate. In skeletal muscle the phosphate supplement could not prevent fall in HEP levels, possibly because of a post-traumatic insulin resistance in muscle tissue, which may prevent uptake of phosphate into muscle cells.

Animals↗
PubMed1983

Hypophosphataemia and muscle phosphate metabolism in severely injured patients.

Severe trauma is associated with increased expenditure of energy, which leads to heightened cellular requirements for regeneration of high energy phosphates (HEP). The effect of multiple traumata and of burns (18 and 12 patients, respectively) on serum phosphate (S-P) and muscle phosphate metabolism was studied. Blood and muscle samples were obtained 2, 4, 8 and 30 days after the injury. The results of analyses were compared with findings in 14 non-traumatized controls. S-P showed a decrease 2 and 4 days after the injury, despite a phosphate supply of 0.4 mmol/kg BW/day. Reduction of HEP and inorganic phosphate of muscle tissue (Pi) was observed on post-trauma days 2, 4, 8 and 30. No correlation was found between Pi and S-P. The fall in S-P, HEP and Pi was not affected by increasing the phosphate supply from 0.4 to 1.0 mmol/kg BW/day. In patients older than 60 years, the reduction of S-P, and adenosine triphosphate was greater than in the younger patients. The results suggest that the S-P decrease was due to loss via the urine and a shift from extracellular to intracellular compartment. The fall in Pi and HEP probably was caused by impaired ability of the cells to utilize the phosphate available in serum, and direct cellular loss of phosphate resulting from hypermetabolism and catabolism.

Adolescent↗
PubMed1982

Effect of beta-blocking agents on peroperative changes in serum phosphate.

Hypophosphataemia in association with surgical trauma is usually attributed to hyperalimentation with glucose solution, or of phosphaturia due to haemodilution. We have shown that it can be induced by trauma, and probably forms part of the humoral response of trauma. In experimental studies on pigs we found that the post-traumatic fall in serum phosphate is bi-phasic, and that the first phase can be prevented by beta-blocking agents. In the present study we compared the peroperative phosphate variations in 7 thyrotoxic patients undergoing elective thyroid surgery while under treatment with beta-blocking agents with those 10 patients submitted to elective surgery (5 thyroid and 5 knee operations) but not receiving beta-blocking agents. We found that the peroperative fall in serum phosphate was prevented in patients receiving beta-blocking agents. This supports the hypothesis that the rapid fall in serum phosphate in immediate association with operative trauma is mediated through the release of catecholamines.

Adrenergic beta-Antagonists↗
PubMed1982

Intramural haemorrhage of the intestine as an indirect effect of missile trauma.

An experimental model for the study of intramural haemorrhages in the intestinal wall following indirect trauma by low-velocity missile is presented. Penetrating or non-penetrating abdominal gun-shot wounds were inflicted on pigs. The macro- and microscopical appearance and development of the haematoma-like lesions were studied. The commonest sites of early (ca. 0.5 h) microscopical lesions were the loose submucosal connective tissue and the mucosa. Mucosal ulcerations were seen in about half of the pigs after 1.5 h. They were probably caused by severe circulatory disturbance after bleeding in the submucosa and mucosa. Later perforating lesions also developed, but not until after ca. 24 h.

Animals↗