Biomedical subjects
Publications and source records attributed to T Lund.
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A total of 4352 patients were admitted to a prospective' randomised multicentre trial comparing the prophylactic efficacy of dextran 70 and low-dose heparin against fatal pulmonary embolism after elective operations for general, orthopaedic, urological, and gynaecological conditions. Out of 3984 patients correctly admitted, 1993 were allocated to receive dextran 70 and 1991 to receive low-dose heparin. Withdrawal of prophylaxis because of bleeding or technical difficulties occurred more often in the heparin group, but allergic reactions were more common in the dextran group. Of the 75 patients who died within 30 days after operation, 38 had been given dextran and 37 low-dose heparin. Necropsy was performed in 33 and 32 of these cases respectively. In six patients in each group pulmonary embolism was the sole or a contributory cause of death. Of these, five patients in the dextran group and two in the heparin group had received a full course of prophylaxis. There was no statistically significant difference between the two treatment groups in the incidence of fatal pulmonary embolism after a full course of prophylaxis.
1. The biosynthetic precursor of renin (preprorenin) from mouse kidney is a single chain polypeptide with a molecular weight of 50 000. 2. This is the same value as previously found for mouse submaxillary gland pre-prorenin. 3. Mouse kidney pre-prorenin (mol. wt. 50 000) is larger than the enzymatically active renin (mol. wt. 40 000).
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The transplacental passage of diazepam (DZ) was studied in 32 cases of vaginal breech delivery. DZ (30 mg) was injected intravenously 15--170 seconds before delivery in order to induce sleep, and general anaesthesia was maintained with N2O/O2. The concentration of DZ was measured in blood obtained from the mother, the umbilical cord and the newborn. In the majority of the infants the drug concentrations in mixed cord blood and in capillary blood at the age of 2 hours were lower than previously observed in infants with cephalic presentations delivered by forceps. The short injection-delivery (I-D) intervals in breech deliveries may limit the transfer of drug to the foetus, but cord compression and circulatory changes may also lead to reduced materno-foetal exchange of DZ.
The rate of transplacental passage of diazepam (DZ) has been studied in 33 cases of cephalic presentation where operative forceps delivery was indicated by intrauterine hypoxia or by prolonged second stage of labor. The drug (30 mg) was injected intravenously immediately before delivery either during uterine contractions (Group I) or in the relaxation period (Group II) according to a randomized protocol. As judged by the concentration in the newborn and the child/mother concentration ratio at 2 hr after delivery, and the concentration on the second day, the fetal exposure to the drug was probably less when the injection was timed to coincide with uterine contractions. In the group of patients given the drug in the relaxation period, the injection-delivery (I-D) interval was up to 305 sec and the 2-hr child/mother concentration ratio was close to unity in some cases. It therefore appears that the transplacental passage of DZ is rapid when the high initial concentrations in the maternal circulation coincide with favorable conditions for transfer in the relaxation period. Although sleep was induced by the injection of DZ in all of the mothers, the amounts of drug transferred during the short I-D intervals in the present study did not exert delterious effects on the newborn infants.
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One of the obvious acute features of cutaneous thermal injury is the swelling of the involved tissue. This swelling is caused by a fluid shift from circulating plasma. Along with the evolution of intravenous fluid therapy in trauma and surgery, the implementation of such therapy to burn victims has improved survival. Edema generation aggravated by fluid therapy may, however, represent a source of increased morbidity. This paper presents a review of the literature on postburn edema generation, focusing mainly on fluid physiology. It is well documented that fluid is lost from the circulation into burned tissue because of a moderate increase in capillary permeability to fluid and macromolecules and a modest increase in hydrostatic pressure inside the perfusing microvessels. Recently it was discovered that a very negative interstitial pressure develops in thermally injured skin. This pressure constitutes a strong "suction" adding markedly to the edema generating effect of increased capillary permeability and pressure.