Biomedical subjects
B Brodin
Publications and source records attributed to B Brodin.
Hospital staff members are satisfied with their jobs.
Job related satisfaction was evaluated by registered nurses, physicians, nurse assistants and aids at an internal medicine clinic at a university hospital in Sweden. A questionnaire concerning cooperation, work load, support, independence and other work related factors was developed and filled out by 153 individuals. The results mostly show high job satisfaction in all professional groups. Nevertheless, nearly half of the staff wanted to quit their jobs. Those who planned to leave their jobs perceived themselves as less satisfied with such factors as cooperation, job complexity, help received from superiors and sufficient time for care delivery, than did those who did not plan to quit. The differences were most evident in the group of registered nurses. The head nurse appeared to have an important supportive function. In conclusion, the results suggest that a supportive organization might reduce personnel turnover in hospitals.
Measurement of fibronectin concentration in benign and malignant ascites.
Fifty-eight consecutive patients who were admitted to two departments of general surgery with ascites of unknown origin were investigated by measurement of ascitic fluid fibronectin concentration in a prospective study. A fibronectin concentration of 100 ml/l or more was chosen as indicative of malignant disease. In 40 patients with malignant disease, the median fibronectin concentration was 160 mg/l (interquartile range 120-270, range 20-560). In 18 patients with ascites from benign disease the corresponding figures were 40 mg/l (30-70, 20-90) (p less than 0.01). The diagnostic specificity (predictive value of a positive test) was 1.00 (34/34) (95% confidence interval 0.90 to 1.00), while the diagnostic sensitivity (predictive value of a negative test) was 0.75 (18/24) (95% CI 0.53 to 0.90). In this series an ascitic fluid fibronectin concentration of 100 mg/l or more indicated malignant disease, but a lower value did not exclude it. The test should be investigated in combination with another test with high diagnostic sensitivity to optimise its diagnostic value.
Low dose norepinephrine in patients with septic shock and oliguria: effects on afterload, urine flow, and oxygen transport.
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Coagulation, fibrinolysis, and kallikrein systems in sepsis: relation to outcome.
Fatal multiple organ failure after severe infection may be related to an early activation of protease cascade systems. This study aimed to relate changes in coagulation, fibrinolysis, and kallikrein to shock and outcome. Of 53 patients with severe infection, 30 did not develop shock, 12 survived septic shock, and 11 died from organ failure after septic shock. No patient had overt disseminated intravascular coagulation. We measured 17 components of the coagulation/fibrinolysis/kallikrein pathways on admission and on the next 2 days. High values for fibrinogen, factor VIII:C, von Willebrand factor antigen, and D-dimer were seen in all patients; factor XII, prekallikrein, factor VII, antithrombin, protein C, and fibronectin were low. The patients thus appeared to be hypercoagulable. These disturbances were more pronounced in septic shock survivors, who also had low plasminogen and antiplasmin, indicating ongoing fibrinolysis. Nonsurvivors of sepsis were distinguished mainly by high plasminogen activator inhibitor values; this suggests an impaired functional fibrinolysis in fatal sepsis, with possible therapeutic implications. Cryoprecipitate infusion increased the fibronectin concentration, but did not influence the other factors studied.
Living and learning. Earning a hearing.
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Elevated levels of plasma hyaluronan in septicaemia.
Hyaluronan (hyaluronic acid) is normally rapidly cleared from the circulation by the endothelial cells in the liver sinuoids, which make up part of the reticulo-endothelial system (RES). An impaired RES function in severe infection and sepsis might therefore lead to elevated hyaluronan plasma levels. Thus, plasma concentrations of hyaluronan were analysed in 44 patients with severe infection at onset of disease and twice during the following 2-3 days. The patients were divided with respect to severity of disease; no septic shock (n = 29), group 1), septic shock survivors (n = 7, group 2), and septic shock non-survivors (n = 8, group 3). Patients in group 1 showed significantly higher values of plasma hyaluronan on day 1 (p less than 0.05) compared with controls. There was no significant difference on the following two sampling occasions. Patients with septic shock (groups 2 and 3) showed higher values than both controls (p less than 0.001) and patients with severe infection without septic shock (group 1, p less than 0.001) at all three sampling occasions. Non-survivors of septic shock (group 3) had significantly higher values than survivors (group 2), (p less than 0.01-0.05). Septic shock, and especially fatal septic shock, thus appears to be associated with elevated plasma hyaluronan concentrations. Possible mechanisms might be an increased release of the polysaccharide from the interstitial space to the bloodstream, or a decreased rate of clearance by liver endothelial cells. This question demands further study.
[Content of fibronectin in ascites--a method for differentiation of malignant and benign disease].
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Cryoprecipitate infusion fails to improve organ function in septic shock.
Plasma fibronectin may be of critical importance for the septic patient through its proposed function as the major opsonin for macrophage clearance of circulating, noncellular debris. As a rule, critically ill, septic patients are depleted of fibronectin. In earlier uncontrolled studies, infusion of fibronectin-rich cryoprecipitate had resulted in improved renal and pulmonary functions and changes in peripheral hemodynamics. In this controlled study, 32 septic ICU patients (mean initial fibronectin level = 60% of normal) received cryoprecipitate or control infusions. Although the fibronectin level was significantly elevated to the normal range in the cryoprecipitate group, no effects were seen in hemodynamics, oxygen metabolism, or lung and kidney functions. Our results indicate that this form of fibronectin therapy does not influence the impaired organ function in septic shock.
[Remarks on the article by F. Lackner et al.: Gelatin as a blood substitute depresses plasma fibronectin for 2 to 3 days after infusion].
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Influence of epidural blockade on postoperative plasma fibronectin concentrations.
To investigate the influence of neurogenic and hormonal stimuli during and after surgery on plasma fibronectin levels, 16 females undergoing cholecystectomy were studied. Eight patients received general anaesthesia, and eight also received a thoracic epidural block with local anaesthetic, which was maintained for 24 h postoperatively. The epidural group had significantly lower plasma levels of adrenaline and cortisol than the general anaesthesia group in the postoperative period. The previously well-documented early decrease in plasma fibronectin concentration following surgery was observed, and was essentially parallel with that of albumin, pre-albumin and thyroid hormones, with no differences between the groups. However, the restoration of the fibronectin level was slower in the epidural group, with significantly lower values as compared with controls at 48 and 72 h after surgery (p less than 0.01-0.001). It was concluded that the post-traumatic plasma fibronectin decrease is not mediated by neurogenic or adrenal stimuli. Such stimuli may, however, influence the subsequent restoration of the plasma fibronectin concentration.
[Plasma exchange with fresh frozen plasma in the treatment of thrombotic thrombocytopenic purpura].
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Plasma fibronectin concentration in suspected septicaemia is related to severity of sepsis.
Low plasma fibronectin levels have been reported in patients with septic complications following surgery, major trauma or burn injury. Our purpose was to evaluate fibronectin in suspected septicaemia and its relationship to severity of infection and clinical outcome. In 51 consecutive patients with infection classified as mild (group A), severe (group B) or severe complicated by septic shock, disseminated intravascular coagulation or multiple organ failure (group C), the respective mean initial fibronectin concentrations were 85% +/- 10 (SD), 55% +/- 15 and 44% +/- 13 of the reference mean (0.35 g/l). In statistical analysis the groups differed significantly from each other and from controls. All 11 patients with mild infection had fibronectin values above the lower reference limit, which was 60%, whereas in 15 of 16 group C patients and all seven fatal cases in that group the initial fibronectin values were below 60%. Plasma fibronectin rose with clinical improvement, but remained low in patients with persisting septicaemia. The results confirmed earlier reports of low fibronectin levels in septic states, and indicate that low concentration is of prognostic value and is related to the severity of the disease.
A hemodynamic profile diagram and its application in septic patients.
A physiologic profile is presented in the form of a circular diagram, in which hemodynamic parameters, oxygen uptake and arterial lactate are displayed on 12 radial spokes. Results are presented as per cent of reference values. In the normal state the profile will be evenly circular, while different circulatory disturbances present typical patterns. This is shown in serial measurements on 12 septic patients, who displayed increases in cardiac output, oxygen metabolism, stroke volume, heart rate, pulmonary artery pressure, right atrial pressure, pulmonary capillary wedge pressure and arterial lactate, while pulmonary and systemic vascular resistances were decreased. Stepwise multiple regression analysis indicated that systemic vascular resistance was the best early discriminator between survivors and non-survivors. The hemodynamogram offers a compact and easily understood presentation of data, which makes it possible to follow the course of the disease and provides a diagnostic and didactic tool.
Fibronectin and other DIC-related variables in patients with moderately severe infections receiving cryoprecipitate.
Plasma fibronectin (Fn), a glucoprotein of suggested importance in host defence during infections also seems to be involved in blood coagulation and to be consumed during clot formation. Low Fn concentrations have been found in patients with DIC, but also in patients with infections without signs of overt DIC. In a randomized trial of Fn supplementation 28 patients with moderately severe infections, hospitalized in the Department for Infectious Diseases, were scheduled to receive either cryoprecipitate from 30 donors (n = 14) or 250-300 ml of stored plasma (n = 14). To elucidate the relationship between Fn plasma levels, Fn-rich cryoprecipitate infusion, and possible low-grade DIC in these patients, we measured platelet count, prothrombin complex (NT), fibrinogen, F V, F VIIIR:Ag, F VIII:C, F XII, plasminogen (Plg), antiplasmin (AP), antithrombin III (AT), kallikrein-inhibiting activity (KI) and spontaneous proteolytic activity (SPA). Compared to healthy controls, high initial values (p less than .001) were found for fibrinogen, F VIIIR:Ag, F VIII:C and SPA. Most values for platelets, F V, Plg, AP and KI were within the reference range. Low levels (p less than .001) were found for Fn, NT, F XII, AT and for the ratio F VIII:C/F CIIIR:Ag. A significant correlation was found between F XII, Plg and AT. Fn correlated poorly to the other variables. Cryoprecipitate infusion normalized the Fn concentration, but had no influence on other measured variables. Thus, although no patient had clinically overt DIC, and all survived, we observed a distinct pattern indicating activation of the coagulation system. Fn levels were low, but were not specifically related to this activation.
Fibronectin and other DIC-related variables in septic ICU patients receiving cryoprecipitate.
In a controlled study of fibronectin supplementation in sepsis, 11 ICU patients in septic shock were scheduled to receive either cryoprecipitate from 20-40 donors (n = 6) or 250-300 ml of stored plasma (n = 5) (two infusions over 24 h). We wanted to: compare some "conventional" DIC variables in the ICU (platelet count, prothrombin complex = NT, FDP) to additional variables: Fibronectin (Fn), fibrinogen (Fg), F V, FVIII R:Ag, F VIII:C activity, F XII, plasminogen (Plg), antiplasmin (AP), antithrombin (AT), kallikrein inhibiting activity (KI) and spontaneous proteolytic activity (SPA): study the effects of cryoprecipitate or plasma infusion on three variables. Samples were taken before the first infusion, and 24 and 48 h after. At onset, high levels (p less than .001 when compared to blood donors) of Fg, VIIIR:Ag and VIII:C were seen. KI levels were within the normal range. F V was low (p less than .05). Fn, NT, XII, Plg, AP and AT were markedly low (p less than .001). SPA showed great variation. When compared to 28 patients with severe infections, but not in septic shock, the ICU group had higher VIIIR:Ag (p less than .05) and VIII:C (p less than .01), and lower XII, Plg, AP and AT (p less than .001). FDP was elevated in all ICU patients. Five patients were thrombocytopenic, and in these a pattern with low levels of Plg and AT was observed. Fn did not correlate well to the other variables measured. These results indicate a marked activation of coagulation and fibrinolysis in these severely ill patients.(ABSTRACT TRUNCATED AT 250 WORDS)
Decrease of plasma fibronectin concentration following infusion of a gelatin-based plasma substitute in man.
Intravenous infusion of 500 ml of a gelatin-based plasma substitute, Haemaccel, given to healthy volunteers, resulted in a significant decrease of the immunoreactive plasma fibronectin concentration 48 h and 72 h after infusion. One hour after infusion, the ability of fibronectin to bind gelatin was inhibited with a gradual recovery within 48 h. A dextran based plasma substitute, Macrodex, did not have this effect on plasma fibronectin.
Low plasma fibronectin indicates septicaemia in major burns.
Plasma fibronectin was measured by laser nephelometry in 23 patients with 20--85% burns. Control measurements were made in 118 healthy blood donors aged 18--60 years. The reference level was significantly higher in the 72 males (mean +/- SD = 377 +/- 70 mg/l) than in the 46 females (327 +/- 55 mg/l). In the burn-injured patients the mean fibronectin concentration was significantly lower than the reference values for one week after the injury. All the patients had low concentrations, about 70% of their respective reference means, in the first 24 hours after the injury. When burn treatment was successful, the fibronectin thereafter increased, gradually exceeding the reference level. Patients with septic complications, by contrast, showed further reduction of fibronectin levels. In the patients who died, the fibronectin concentration 6--10 days after burn injury was significantly less than in the patients who survived. On the basis of these results, repeated analysis of plasma fibronectin in the early postburn period is recommended. Persistent fibronectin deficiency then is an indicator of imminent septicaemia, vital organ failure and risk of fatal outcome.