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Biomedical subjects

A Hole

Publications and source records attributed to A Hole.

At least 19 recordsLinked to original sources
PubMed2004

Occupational asthma caused by cellulase and lipase in the detergent industry.

Three employees from two different detergent companies were investigated for occupational asthma, using skin prick tests, serum specific IgE, and specific bronchial challenge. Two were challenged with lipase and one with cellulase. All three cases had immunological evidence of sensitisation to the detergent enzymes with which they worked. Bronchial challenge in each provoked a reproducible dual asthmatic response, which reproduced their work related symptoms. These are the first reported cases of occupational asthma attributable to cellulase and lipase in the detergent industry. Four of the most common enzymes used in this industry have now been reported to cause occupational asthma; continued vigilance and caution are needed when working with these or other enzymes.

Adult↗
PubMed2002

A randomised study of prophylactic G-CSF following MRC UKALL XI intensification regimen in childhood ALL and T-NHL.

BACKGROUND: Despite the current widespread use of prophylactic G-CSF in children with solid tumours and leukaemia, its effectiveness has not been clearly demonstrated. This randomised study evaluates the role of G-CSF given after a 5-day intensification block in children with acute lymphoblastic leukaemia (ALL). PROCEDURE: Forty-six children with ALL or T-Cell non-Hodgkins lymphoma (NHL) treated on MRC ALL 97, UKALL XI or UKCCSG 9504 NHL protocols were randomised to receive granulocyte colony-stimulating factor following either the first or the second block of intensive chemotherapy in a cross-over study to determine if the prophylactic administration of G-CSF could reduce the rate of readmission to hospital for management of febrile neutropenia. RESULTS: There was a statistically significant difference in the rate of hospital admission in the group receiving prophylaxis, with 34 of 46 being admitted, compared to 42 of 46 patients in the control arm (74 vs. 91%; P=0.0386). There were no differences found in duration of hospital admission, haematological toxicity, neutrophil recovery or duration of supportive care between the two groups. There was no demonstrable cost benefit derived from the prophylactic administration of G-CSF. CONCLUSIONS: This study shows that the prophylactic administration of G-CSF following intensification chemotherapy for childhood ALL and T-NHL produces a significant reduction in the rate of readmission to hospital for the management of febrile neutropenia.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed2002

Reference intervals for procalcitonin and C-reactive protein after major abdominal surgery.

Procalcitonin (PCT). a new marker proposed as a diagnostic tool for bacterial infections, triggers a systemic-inflammatory reaction in the body (sepsis, septic shock) and has potential use in a wide range of patient settings. To interpret the results from PCT measurements, we depend on reference intervals established from relevant populations. PCT and C-reactive protein (CRP) concentrations were analysed in 47 patients with a normal postoperative course after major abdominal surgery. The mean concentration of PCT declines from the first day and reaches half its initial values on the second day after the operation. whereas the mean concentration of CRP increases in the first 48 h and reaches half its maximum value on the fifth day after the operation. We present a continuous reference interval for plasma PCT and CRP concentrations in the first week following major abdominal surgery. For PCT we also present a graphic display of expected mean and expected upper reference limits predicted from the value measured on the first postoperative day.

Abdomen↗
PubMed1994

Biphasic time-course of serum concentrations of clomipramine and desmethylclomipramine after a near-fatal overdose.

A 27-y-old male was admitted deeply comatosed 5-6 h after taking approximately 15 g clomipramine. The prominent feature of the case was a biphasic course of clomipramine and desmethylclomipramine serum concentrations, possibly caused by delayed drug absorption. Clinically, 2 serious episodes requiring mechanical ventilation and aggressive pressor agent infusions occurred as the serum concentrations declined. However, the severe adult respiratory distress syndrome--related inflammatory process that required 4 w of intensive care may also be an explanation, although blood cultures were negative and neither liver nor renal functions were severely compromised.

Adult↗
PubMed1988

Pharmacokinetics of midazolam and alfentanil in outpatient general anesthesia. A study with concomitant thiopentone, flumazenil or placebo administration.

The pharmacokinetics of alfentanil, midazolam and thiopentone used for induction of short general anaesthesia were studied in 55 gynaecological outpatients. All the patients received midazolam as premedication. The patients received intravenous anaesthesia with alfentanil and either thiopentone or midazolam, supplemented with either nitrous oxide or air in oxygen ventilation, reversed by the end of anaesthesia with either placebo or flumazenil. Blood sampling for serum concentration measurements of midazolam, alfentanil and thiopentone was performed regularly for 7 h. The following mean pharmacokinetic parameters (mean +/- s.e. mean) were calculated for midazolam and alfentanil, respectively: elimination half-life 3.9 +/- 0.3 h and 1.2 +/- 0.05 h, apparent volume of distribution 107 +/- 61 and 31 +/- 1.5 l, total body clearance 20 +/- 0.7 l/h and 18 +/- 0.8 l/h. No influence of flumazenil on the kinetics of midazolam and no influence of thiopentone, midazolam, flumazenil or nitrous oxide on the kinetics of alfentanil was found. The serum levels of thiopentone were below the detection limit of the assay after 60 min, which made an evaluation of pharmacokinetic parameters impossible. Significant positive correlations were found in the individual patient between midazolam and alfentanil for all pharmacokinetic variables evaluated. For midazolam, an increase in the elimination half-life and the apparent volume of distribution was positively correlated to an increase of body-weight. For alfentanil, a decrease in the total body clearance and an increase in the elimination half-life were positively correlated to an increase of age. A prolonged elimination half-life of alfentanil was positively correlated to use of alcohol. High serum levels of thiopentone were positively correlated to increasing age of the patients.

Adult↗
PubMed1987

Total intravenous anaesthesia with midazolam and flumazenil in outpatient clinics. A comparison with isoflurane or thiopentone.

Total intravenous anaesthesia with midazolam and alfentanil, reversed with the benzodiazepine antagonist flumazenil, was studied in patients admitted for outpatient gynaecological dilatation and curettage. One hundred patients were randomly allocated to four groups with different anaesthetic techniques: I: alfentanil and thiopentone induction, 66% N2O maintenance; II: alfentanil and midazolam sedation prior to isoflurane and N2O induction and maintenance; III: midazolam and alfentanil induction; oxygen/air, placebo reversal; IV: midazolam and alfentanil induction, oxygen/air, flumazenil reversal. All methods of anaesthesia proved satisfactory with no serious side-effects or complications. Induction was faster in Group I (26 s) compared with Group III and IV (37-38 s) and Group I (62 s). Respiration was less depressed in Group II compared with the other groups. Recovery function was better in Group IV during the first 30 postoperative min and worse in Group III during the first 120 postoperative min compared with the other groups. Reduced performances in P-deletion and 4-choice reaction-time tests in the midazolam patients were not reversed by 0.5 mg flumazenil, suggesting that flumazenil did not antagonize all benzodiazepine effects in our patients. Postoperative amnesia was most pronounced in Group III. There was no significant difference in patient function 7 h postoperatively, at home in the evening or during the next days. We conclude that total intravenous anaesthesia with alfentanil and midazolam with flumazenil reversal is a promising technique for short outpatient anaesthetic procedures.

Adult↗
PubMed1987

Prevention of fat embolism syndrome in patients with femoral fractures--immediate or delayed operative fixation?

From January 1976 until August 1980, femoral fractures in our department were initially stabilized with tibial traction and fixed operatively after 4-7 days. From August 1980 the fractures were treated with immediate operative fixation. In this retrospective study, we compared the incidence of fat embolism syndrome in 106 patients treated with delayed operative fixation to the incidence in 114 patients treated with immediate operative fixation. Eleven patients (10.4%) developed fat embolism syndrome in the group treated with delayed fixation, compared with two patients (1.8%) in the immediate osteosynthesis group (p less than 0.02). We concluded that early operative fixation of femoral fractures seems beneficial for the prevention of fat embolism syndrome.

Adolescent↗
PubMed1986

Out-patient laparoscopy in general anaesthesia with alfentanil and atracurium. A comparison with fentanyl and pancuronium.

The effects of the new intravenous anaesthetic drugs alfentanil (50 micrograms/kg) and atracurium (0.5 mg/kg) on per- and post-operative function in out-patients clinics were compared with fentanyl (5 micrograms/kg) and pancuronium (0.07 mg/kg). Sixty-two healthy female patients submitted for out-patient sterilization by laparoscopy participated in the study. Thirty patients receiving alfentanil and atracurium (the AA-group) had significantly less pain during analgetic injection, less coughing during intubation, and faster and more pronounced muscle relaxation during induction of anaesthesia, compared with 32 patients receiving fentanyl and pancuronium (the FP-group). The AA-group had less adrenocortical stress-response judged by systolic blood pressure and pulse rate during anaesthesia. Reversal of anaesthesia and neuromuscular blockade were performed without differences in awakening parameters between the two groups. The AA-group had a significantly better score on P-deletion test 45 min after reversal of anaesthesia, a better street fitness score in the afternoon after the procedure and a better day-life function score at home in the evening. There was no difference between the groups in postoperative complaints and in function after the day of operation.

Activities of Daily Living↗
PubMed1986

Alfentanil anaesthesia in gall-bladder surgery.

Five different dosage schemes for alfentanil administration supplemented with thiopentone, pancuronium and N2O/O2 have been studied in 25 patients undergoing elective cholecystectomy. Six patients in the high dosage group experienced stiff chest during induction and five patients developed respiratory arrest on the recovery ward. The effects of the different schedules in blocking the surgical stress response have been elucidated by serial measurements of serum cortisol and glucose, heart rate and systolic blood pressure. There were no significant changes in serum cortisol, heart rate and blood pressure during anaesthesia and surgery in any group. All patients showed a significant increase in serum cortisol 2 h postoperatively. There was significant elevation of serum glucose after 1 h of surgery in two groups (maintenance dose 1 microgram/kg/min of alfentanil) and in all groups except one (maintenance dose 3.0 micrograms/kg/min) 2 h postoperatively. High dosage of alfentanil resulted in frequent stiff chest during induction and respiratory arrest postoperatively. High dosage did not seem to give any additional benefits in blocking the surgical stress response in this type of surgery.

Adult↗
PubMed1984

Depression of monocytes and lymphocytes by stress-related humoral factors and anaesthetic-related drugs.

The in vitro effects of six anaesthesia-related drugs and five stress-related serum factors on monocyte-mediated cytolysis and thymidine uptake in mitogen-(PHA)-stimulated lymphocytes have been studied. Thiopentone depressed both the monocyte and lymphocyte function in a dose-dependent way. However, at thiopentone concentrations which may be present in the serum after a single intravenous anaesthesia induction dose, the monocyte depression was moderate and depression of the lymphocytes was not observed. The other drugs tested, fentanyl, morphine, pancuronium, diazepam and bupivacaine, did not alter the cellular functions significantly. Prostaglandin-E2 in concentrations of 10(-6) and 10(-7) M markedly depressed monocyte-mediated cytolysis. Cortisol, catecholamines and serotonin did not alter this function. However, a synergistic depressive effect of the combination of prostaglandin-E2 and cortisol was observed. The proliferative response of PHA-stimulated lymphocytes was depressed by cortisol in concentrations of 2200 nmol/l and 1100 nmol/1 Again, there was a marked synergistic effect of the combination of cortisol and prostaglandin-E2, while prostaglandin-E2 alone, catecholamines and serotonin did not influence the PHA-response. A possible explanation for the depression of monocyte-mediated cytolysis and lymphocyte-thymidine uptake during and after surgery under general anaesthesia may be the combined effect of endocrine and local stress factors.

Anesthetics↗
PubMed1984

Per- and postoperative monocyte and lymphocyte functions: effects of sera from patients operated under general or epidural anaesthesia.

Effects on monocyte-mediated cytolysis and thymidine uptake in PHA-stimulated lymphocytes were studied with cells from healthy donors and sera from patients undergoing hip replacement under epidural- or general anaesthesia. Sera were sampled before induction of either epidural- or general anaesthesia (I), 15 min after induction of anaesthesia (II), during surgery 60-90 min after start of induction of anaesthesia (III), and the next morning at 8 o'clock (IV). Serum sample II from patients operated under general anaesthesia significantly depressed both monocyte cytolysis and thymidine uptake in lymphocytes. At sampling time III and IV the monocyte cytolysis was insignificantly reduced. There was no suppression of lymphocyte-thymidine uptake at these sampling times. The sera from patients operated under epidural anaesthesia did not influence the thymidine uptake in lymphocytes. However, sera drawn from epidural anaesthesia patients at sampling time IV significantly depressed the monocyte cytolysis (the sample was drawn the next morning 3-4 h after discontinuation of the epidural anaesthesia). We conclude that the depressive effect of surgery under general anaesthesia on monocyte cytolysis and lymphocyte proliferation is partly transferable by serum factors. The depressive effects on monocytes and lymphocytes of sera drawn 15 min after induction of general anaesthesia may be due to the effect of the induction of thiopentone.

Aged↗
PubMed1984

T-lymphocytes and the subpopulations of T-helper and T-suppressor cells measured by monoclonal antibodies (T11, T4, and T8) in relation to surgery under epidural and general anaesthesia.

Monoclonal antibodies reacting with specific determinants on lymphocytes and their subpopulations were used to study the influence of surgery under general or epidural anaesthesia on the number of T-cell (T11), T-suppressor cells (T8), and T-helper cells (T4). The T-cell fraction decreased significantly during surgery, but was only moderately reduced on the first postoperative day. The change in the T-cell fraction was the same under both types of anaesthesia. The helper and suppressor cell fractions were not significantly altered at any time during the study, and again there was no difference between the two anaesthetic regimens. The ratio of helper cells to suppressor cells (the T4/T8 ratio), which is widely used as an indicator of immunosuppression, showed no significant variations during the study, even though there were individual variations. Changes in the T4/T8 ratio were not correlated to the amount of blood transfusions, nor was there any correlation between the T4/T8 ratio and the thymidine uptake in mitogen-(PHA)-stimulated lymphocytes. T-lymphocytes are depressed during and after surgery under general anaesthesia. From the present study, this does not seem to be due to changes in the balance between helper- and suppressor T-cells.

Aged↗