[A liberal abortion practice. Legal abortions in Umeå during 1963-1967].
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Abortion, Legal↗
Biomedical subjects
S Sandstedt
Publications and source records attributed to S Sandstedt.
Influence of total parenteral nutrition on plasma fibronectin in malnourished subjects with or without inflammatory response.
Plasma fibronectin, which is an alpha 2-glycoprotein of importance for the immunodefence, has been reported to decrease after starvation and in severely ill patients with cancer. To evaluate the usefulness of fibronectin as an indicator of nutritional repletion, 18 patients with gastrointestinal disorders were studied over a 2-wk period of total parenteral nutrition (TPN). According to nutritional assessment on admission the patients were divided into well nourished (n = 6) and malnourished (n = 12). For comparison nine patients with anorexia nervosa were also studied over a 3-wk period of TPN. Before and after TPN fibronectin, albumin, prealbumin, transferrin, and two acute-phase reactants, haptoglobin and orosomucoid were measured in plasma. The majority of the malnourished patients had an inflammatory reaction in contrast to only a few of the well-nourished and anorexia nervosa patients. Of the proteins measured, only fibronectin rose significantly in the malnourished patients (malnourished and anorexia nervosa), but not in the well nourished patients during TPN. Our results may indicate the usefulness of fibronectin as an indicator of short-term TPN in malnourished subjects, irrespective of the presence or absence of inflammatory response.
Adolescent↗
Skeletal muscle function and metabolism in obese women.
A possible mechanism to regulate body weight during a high calorie intake may be an increased metabolic rate in skeletal muscle. To approach this hypothesis the energy metabolites, ATP, phosphocreatine, creatine, glycogen and lactate were measured in biopsies from the quadriceps femoris muscle. Concomitantly the function of the adductor pollicis muscle was studied as assessed after electrical stimulation of the ulnar nerve. The muscle function variables were, force of contraction at 5, 10, 20, and 50 Hz of stimulation, relaxation rate, and endurance. Eight obese women were studied before gastroplastic surgery and 6 months postoperatively and a weight loss of 19.4 +/- 3.4% (mean +/- SEM). Preoperatively ATP, phosphocreatine, glycogen, and lactate were significantly decreased and the same pattern was found postoperatively. These findings can be related to a low production of energy-rich phosphates or a high energy utilization. Both pre- and postoperatively there was, a decreased force of contraction at 10 Hz of stimulation (p less than 0.001), a faster relaxation rate (p less than 0.01) and a normal endurance. These functional results indicate a high metabolic rate. At admission a decreased serum insulin level indicated a moderate insulin resistance which was normalized after the weight loss. The triiodothyronine concentration was normal before and after operation. In conclusion our findings of changed muscle energy metabolite concentrations and altered muscle function indicate a high metabolic rate in skeletal muscle in obese women. This may be an adaptation in skeletal muscle energy metabolism to a high body weight.
Adult↗
Percutaneous, tunneled silicone elastomer central venous catheters for total parenteral nutrition: low sepsis and thrombosis rate. A prospective study of 315 catheters.
Silastic catheters were inserted by the percutaneous route, and tunneled subcutaneously, in 315 patients who needed venous access for total parenteral nutrition. The catheters were managed with a daily program that included heat sterilization of the metal hub with an electrical soldering iron. This study aimed to evaluate prospectively the incidence of catheter-related sepsis and thrombosis. There was one case of pneumothorax. All catheters were x-rayed post-insertion: eight catheters were malpositioned initially. The median catheter duration was 18 days with a range of 2-138 days. The total duration was 240 catheter-months. Twenty-seven catheters were removed due to mechanical problems. Nine were removed because of suspected sepsis; six patients had negative blood and catheter cultures, while three grew pathogens. The sepsis rate was thus 0.95%. There were no clinical signs of thrombosis. Pull-out venography was performed in 93 patients. Fibrin sleeves were seen in the majority of cases. Two patients had wall-adherent, non-occlusive thrombus masses (2%); they both had proximal catheter positions. We conclude that there is a low risk of catheter-related sepsis and thrombosis with this technique.
Adult↗
Plasma concentrations and hemodynamic changes after repeated interpleural injections of bupivacaine-epinephrine.
BACKGROUND AND OBJECTIVES: The purpose of this investigation was to study the arterial plasma concentrations of bupivacaine and the hemodynamic changes after interpleural injection of 20 ml 0.5% bupivacaine with epinephrine in patients treated by chest drainage for spontaneous pneumothorax. METHODS: Twenty-two patients with spontaneous pneumothorax planned to be treated by chest drainage were randomly allocated to a bupivacaine group and a control group receiving saline. After introduction of the chest drain and evacuation of the pneumothorax, 10 injections through an interpleural catheter were given at 8-hour intervals in a double-blind fashion. Plasma concentrations were determined at 5, 10, 20, 30, 240, and 480 minutes after the first injection and before and at 15 and 30 minutes after the 4th, 7th, and 10th injections. Heart rate and mean arterial pressure was registered before and at 15 and 30 minutes after each injection. RESULTS: Mean Cmax after the first injection was 1.02 +/- 0.24 microgram/ml at 15 minutes, the highest individual Cmax after 20 minutes being 1.56 micrograms/ml. Mean plasma concentrations increased up to and after the 4th injection but did not rise further after the 7th and 10th injections. The highest individual Cmax was 1.92 micrograms/ml at 15 minutes after the 10th injection. The injections were accompanied by a small but statistically significant reduction in mean arterial blood pressure and a rise in heart rate 15 minutes after injection in the bupivacaine group compared with the control group. CONCLUSIONS: Repeated interpleural bolus injections of 20 ml 0.5% bupivacaine-epinephrine at 8-hour intervals are safe regarding plasma concentrations of bupivacaine. Small but statistically significant hemodynamic changes can be noticed, probably the result of beta- adrenergic stimulation by epinephrine.
Adult↗