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B Rosberg

Publications and source records attributed to B Rosberg.

At least 19 recordsLinked to original sources

A secreted proform of neutrophil proteinase 3 regulates the proliferation of granulopoietic progenitor cells.

Myeloid leukemia cells, the human promyelocytic cell line HL-60, and a subpopulation of normal marrow cells produce a leukemia-associated inhibitor (LAI) that reversibly downmodulates DNA synthesis of normal granulopoietic progenitor cells colony-forming unit granulocyte-macrophage (CFU-GM). We isolated an active 125-kD component of LAI from HL-60 conditioned medium (CM), subjected it to cyanogen bromide cleavage and show by amino acid sequencing of the resulting peptides that it consists of a complex of the serine proteinase inhibitor alpha1-antitrypsin and a 31-kD fragment that retained the S-phase inhibitory activity, but resisted sequencing. This finding suggested that the 31-kD fragment originated from one of the neutrophil serine proteases (ie, elastase, proteinase 3, or cathepsin G) produced by normal promyelocytes, as well as HL-60 cells, for storage in primary granules and partly secreted during synthesis as enzymatically inactive proforms. Immunoblot analysis showed that the 125-kD complex contained proteinase 3 (PR3), and immunoprecipitation of PR3 from HL-60 CM abrogated the S-phase inhibitory activity, whereas immunoprecipitation of cathepsin G or elastase did not. Immunoprecipitation of PR3 from CM of a subpopulation of normal marrow cells also abrogated the S-phase inhibitory effect. Furthermore, CM from rat RBL and murine 32D cell lines transfected with human PR3 both reduced the fraction of CFU-GM in S-phase with 30% to 80% at 1 to 35 ng/mL PR3, whereas CM of the same cells transfected with cathepsin G or elastase did not. Also, an enzymatically silent mutant of PR3 exerted full activity, showing that the S-phase modulatory effect is not dependent on proteolytic activity. Amino acid sequencing of biosynthetically radiolabeled PR3 showed that PR3 from transfected cells is secreted after synthesis as proforms retaining amino terminal propeptides. In contrast, mature PR3 extracted from mature neutrophils has only minor activity. The inhibitory effect of secreted PR3 is reversible and abrogated by granulocyte (G)- or granulocyte-macrophage colony-stimulating factor (GM-CSF). Experiments with highly purified CD34(+) bone marrow cells suggested that PR3 acts directly on the granulopoietic progenitor cells. These observations suggest a role for PR3 in regulation of granulopoiesis, and possibly in suppression of normal granulopoiesis in leukemia.

Cell Division↗

Granulocyte interactions with GM-CSF and G-CSF secretion by endothelial cells and monocytes.

We have, in previous studies, characterized the cytokine and cellular regulation of GM-CSF and G-CSF production by monocytes and endothelial cells. In this study, we investigated the regulatory role of granulocytes. The addition of granulocytes to endotoxin-stimulated monocytes dose-dependently decreased both GM-CSF and G-CSF concentrations, presumably by absorbing the cytokines. A similar dose-dependent decrease in GM-CSF concentration was found when granulocytes were added to IL-1-stimulated endothelial cells. In contrast, G-CSF secretion by endothelial cells responded to granulocytes in a biphasic fashion. At low granulocyte concentrations, endothelial cells responded with an increased G-CSF secretion, but at high concentrations of granulocytes G-CSF secretion was down modulated. Our results suggest that there exist two loops between granulocytes and endothelial cells for regulating G-CSF activity. Granulocytes can stimulate G-CSF secretion by activated endothelial cells but can also decrease the biological activity by absorbing the cytokine. These mechanisms might be involved in the regulation of the local and systemic levels of granulocytes.

Absorption↗

Metabolic, ventilatory and circulatory effects of doxapram in anaesthetized pigs during normoxia and hypoxia.

BACKGROUND: In a previous clinical study doxapram was found to improve ventilatory efficacy postoperatively, presumably via effects on hypoxic pulmonary vasoconstriction (HPV). The present study was designed to see whether doxapram induced any changes of arterial oxygenation and pulmonary vascular resistance during normoxia or hypoxia and whether the changes were influenced by the anaesthetic agents. METHODS: Seventeen piglets were anaesthetized by combinations of either midazolam + fentanyl + pancuronium + pentobarbital (TIVA, n = 9), or by midazolam + fentanyl + pancuronium + halothane, 0.5% in end-tidal gas (Hal, n = 8). Analyses of expired gas and mixed venous and arterial blood in combination with determinations of central blood flow and pressures allowed for calculations of standard metabolic, ventilatory and circulatory data. Values were obtained at normoventilation using normoxic (FIO2 = 0.3) and hypoxic (FIO2 = 0.08) gas mixtures at calculated doxapram plasma concentrations of 1, 2 and 4 micrograms.ml-1. RESULTS: With few exceptions doxapram administration affected the investigated variables only moderately during normoxia. In group Hal, PVR and SVR showed a biphasic raise (P < 0.05), CO fell (P < 0.05-P > or = 0.05) and C (a-v)O2 rose (P < 0.05). In group TIVA, PaO2 fell (P < 0.01-0.05) despite unchanged PVR, CO and VD/VT. Hypoxia affected a moderate increase in PVR in group TIVA (P < 0.05), which was slightly lower at the lowest and highest plasma levels of doxapram (P < 0.05). In group Hal, the induction of hypoxia induced a more pronounced rise in PVR (P < 0.05) which showed a biphasic response to increasing dose levels of doxapram, the lowest dose affecting a further rise (P < 0.05) and the highest a reduction to values below hypoxia control levels (P < 0.05). Pronounced differences between the two groups with respect to values for metabolic and circulatory variables make the interpretation of data difficult. CONCLUSIONS: Doxapram administration to anaesthetized animals did not induce any effects indicative of augmentation of the HPV response.

Anesthesia↗

Bambuterol and terbutaline in human cerebrospinal fluid and plasma.

Concentrations in cerebrospinal fluid (CSF) and plasma of bambuterol and its active metabolite, the beta 2-adrenoceptor agonist terbutaline, were measured in man after four once-daily doses of 30 mg bambuterol hydrochloride (Bambec). Nine patients scheduled for orthopaedic surgery under spinal anaesthesia completed the study. The concentrations of both substances were much lower in CSF than in plasma, the ratio CSF/plasma being 0.09 for bambuterol and 0.19 for terbutaline, at apparent steady state. While the rank order of the ratios was expected from the fractions of unbound bambuterol and terbutaline in plasma, their absolute values were only about 1/6 (bambuterol) and 1/4 (terbutaline) of those predicted from diffusion equilibria between plasma and CSF. Thus, the rates of transport of bambuterol and terbutaline from plasma into the central nervous system appear to be slow relative to transport out of the system, e.g. by outflow of CSF. The findings are in agreement with animal experiments and suggest that bambuterol and terbutaline are less likely than lipophilic beta 2-adrenoceptor agonists to interact with central receptors.

Aged↗

Doxapram improves pulmonary function after upper abdominal surgery.

The effects of doxapram on postoperative pulmonary function were studied in 40 ASA I and II patients randomly allocated to receive either doxapram 1.8 mg.kg-1.h-1 or placebo for 2 h immediately after elective cholecystectomy. The two groups displayed similar reductions of carbon dioxide production at 2 h and 6 h postoperatively, whereas oxygen consumption remained at preoperative levels for 24 h. Minute ventilation was similarly reduced in the two groups at 2 h and 6 h postoperatively, with corresponding increases in PaCO2. PaO2 was similarly and significantly decreased in both groups postoperatively, whereas P(A-a)O2 remained unchanged at 2 h and 6 h in doxapram-treated patients. FRC was reduced postoperatively in both groups, significantly more so in the control group at 6 h. Various indices of intrapulmonary gas distribution, including the functional (nitrogen) dead space, underwent similar changes in the two groups. By contrast, the physiological dead space was reduced in doxapram-treated patients at 2 h, 6 h and 24 h postoperatively, whereas no significant changes were seen in the control group. The ventilatory equivalent for CO2 was significantly lower in the doxapram-treated group, implying higher ventilatory efficiency. Our findings indicate that infusion of doxapram postoperatively attenuates the impairment of pulmonary function postoperatively, chiefly via effects on V'A/Q' ratios. No side effects of doxapram were observed.

Abdomen↗

The influence of different levels of PEEP on peripheral tissue perfusion measured by subcutaneous and transcutaneous oxygen tension.

OBJECTIVE: To compare subcutaneous (PscO2) and transcutaneous (PtcO2) oxygen tension measurements in relation to hemodynamic variables at different levels of PEEP, and to evaluate the usefulness of these measurements as monitors of peripheral tissue perfusion. DESIGN: Prospective trial. SETTING: Intensive care unit in a university hospital. PATIENTS: Seven patients with gastric cancer who where undergoing total gastrectomy. INTERVENTIONS: Silicone catheter was placed in the upper arm and transcutaneous oxygen monitor was placed on the upper part of the chest. A pulmonary artery catheter was placed in the right pulmonary artery. MEASUREMENTS AND RESULTS: PscO2 and PtcO2 together with hemodynamic variables were measured at different levels of PEEP. Progressive increase of PEEP reduced cardiac index (CI) (p < 0.05) with a concomitant decrease of PscO2 (p < 0.05) and oxygen delivery (DO2) (p < 0.05). Changes in PtcO2 paralleled changes in arterial oxygen tension (PaO2), but no correlation was found between PtcO2, CI and DO2. CONCLUSION: PscO2 is a sensitive indicator of subcutaneous tissue perfusion, which can be used to identify the PEEP level, with optimum peripheral perfusion. PscO2 seems to be a more reliable indicator of tissue perfusion than PtcO2.

Aged↗

Pharmacokinetics and clinical experience of 20-h infusions of methohexitone in intensive care patients with postoperative pyrexia.

We have studied the pharmacokinetics of 20-h infusions of methohexitone in young patients with postoperative fever undergoing artificial ventilation of the lungs. The infusion rate was adjusted so that patients were unresponsive to vocal stimulation but reacted to tracheal suction. The mean steady state concentration of methohexitone required was 2.6 mg litre-1 (unbound 0.53 mg litre-1). The mean (SD) total clearance of methohexitone was 16.3 (4.2) ml min-1 kg-1, which is greater than that for volunteers or normal surgical patients. The unbound clearance correlated positively with body temperature during the infusion (r = 0.796, P = 0.017). The terminal half-life of methohexitone was 6.3 (3.8) h and that of the 4'-hydroxy metabolite 5.8 (2.1) h. There were no marked haemodynamic effects of the infusion, and no excessive sedation after the infusion. However, the clearance of methohexitone was high and variable, possibly as a direct effect of postoperative fever. Consequently, the need for individual titration of the rate of infusion is emphasized.

Adult↗

Atracurium and pancuronium in renal insufficiency.

The duration and possible accumulation of atracurium and pancuronium were studied in 59 patients (29 anephric and 30 normal) anaesthetized with 0.5% halothane in O2/N2O and supplemented by fentanyl. Equipotent doses of atracurium (0.5 mg.kg-1) and pancuronium (0.1 mg.kg-1) were given for intubation. Atracurium had a lower potency in anephric patients. The duration (first twitch response (TI) return to 20% of control) for atracurium was 28 min in anephric and 36 in normal patients. The corresponding mean times for pancuronium were 171 and 123 min, but with a very wide variation range 20-380 min and 45-360 min, respectively). The duration of up to 8 incremental doses of atracurium (0.1 mg kg-1) was 27-29 min in normal patients and of up to 13 increments was 25-34 min in anephric patients. Pancuronium (0.015 mg kg-1) was given in a maximum of 4 increments. In normal patients the mean durations were 40-56 min, and in anephric patients 65-100 min. The duration of pancuronium, but not of atracurium, was prolonged with repeated injections (up to 2.7 times) in anephric patients. After pancuronium the spontaneous recovery was significantly slower in anephric patients, while the induced recovery was rapid and reliable in all groups. We conclude that atracurium is a safe and reliable muscle relaxant in normal and anephric patients, while pancuronium in both groups has a disturbing variation in duration and, in addition, signs of significant accumulation in anephric patients. The use of a nerve stimulator is mandatory.

Adult↗

Serum CK-MB is useful in diagnosis of acute myocardial infarction after total hip arthroplasty.

Skeletal muscle trauma and myocardial infarction both increase the serum values of the creatine kinase isoenzyme MB (CK-MB) which may render the diagnosis of perioperative myocardial infarction in major orthopaedic surgery more difficult. The significance of postoperative changes in CK-MB was studied in 30 patients subjected to total hip replacement (THR), and the results were compared to CK-MB in 30 nonsurgical patients with acute myocardial infarction (AMI). AMI patients had significantly higher serum CK-MB values at 24 h than THR patients. However, the highest value after THR exceeded the lowest value in AMI. The results suggest that skeletal muscle release of CK-MB after THR is slight. CK-MB thus also seems useful in the diagnosis of AMI in postoperative patients.

Aged↗

Anaesthetic techniques and thromboembolism in total hip arthroplasty.

Sixty patients who were scheduled for total hip replacement were randomly allocated to receive either epidural blockade or neurolept anaesthesia. All patients received dextran 70. The blood loss during surgery and the mean arterial blood pressure were lower following epidural anaesthesia. However, the frequency of deep venous thrombosis and pulmonary embolism, as diagnosed by ascending phlebography and pulmonary scintigraphy, was the same in the two groups. It is concluded that, although epidural anaesthesia may be considered for other reasons, there is no reduction in thromboembolic complications with this anaesthetic technique in patients who receive dextran.

Anesthesia, Epidural↗

Circulatory effects of haemorrhage during sodium nitroprusside induced hypotension. A study in the rat.

The haemodynamic changes induced by acute moderate blood loss were investigated in rats during normotensive halothane anaesthesia and during sodium-nitroprusside-induced hypotensive anaesthesia, respectively. Following haemorrhage in the normotensive group, mean arterial blood pressure, heart rate and left cardiac work decreased. Cardiac output was reduced non-significantly. Blood flow was redistributed to favour cerebral, coronary, renal and hepatic circulation, mainly at the expense of blood flow to the carcass. Following haemorrhage in the hypotensive group, cardiac output increased significantly. Mean arterial pressure, heart rate and left cardiac work were unchanged. Absolute values for cerebral, coronary, renal and hepatic blood flow were maintained or even increased, while blood flow to the carcass was unchanged.

Animals↗

On thrombo-embolism after total hip replacement in epidural analgesia: a controlled study of dextran 70 and low-dose heparin combined with dihydroergotamine.

A prospective study of thrombo-embolism after total hip replacement in epidural analgesia was carried out in 116 patients, randomly allocated to dextran 70 or low-dose heparin combined with dihydroergotamine (HDHE). Amounts of blood loss and transfused bank blood did not differ significantly between dextran 70 and HDHE prophylaxis. There was a lower incidence of femoral deep vein thromboses in patients given dextran prophylaxis as compared with those on HDHE (P less than 0.05). However, the total frequency of DVT and the frequency of pulmonary embolism did not differ between the two groups. There was no case of fatal pulmonary embolism. The side effects were major bleeding complications in 7 per cent of the HDHE group as compared to none in the dextran group. No anaphylactic reaction was noted from dextran 70 using hapten-dextran prophylaxis.

Aged↗

Postoperative course of serum aminotransferases after total hip arthroplasty.

Skeletal muscle trauma and acute coronary occlusion increase the values of aminotransferases, which might render the diagnosis of myocardial infarction in connection with major orthopaedic surgery more difficult. To find clinically useful distinctions, the postoperative course of serum aminotransferases (ASAT, ALAT, LD, GT and ALP) was recorded for the first 3 weeks following total hip arthroplasty and compared with the values found in patients with acute myocardial infarction. The level of ASAT increased during the first days following surgery. The highest recorded value of ASAT during the first 4 days was found to be lower than corresponding values in patients with myocardial infarction, although an overlap between the groups was seen. However, the LD value did not increase significantly following surgery, in contrast to the findings in patients with myocardial infarction. Later in the postoperative course, values for ALAT, GT and ALP rose as well. Two case reports on myocardial infarction after total hip replacement are included.

Aged↗

Hypotensive anesthesia, thromboprophylaxis and postoperative thromboembolism in total hip arthroplasty.

A prospective study was performed in 120 patients undergoing total hip arthroplasty. The patients were randomly allocated to four groups. The first two groups had nitroprusside-induced hypotensive anesthesia with either a fixed combination of sodium heparin and dihydroergotamine mesylate (HDHE) or dextran 70. The other two groups had normotensive halothane anesthesia with either HDHE or preoperative hemodilution with dextran 70. Hypotensive anesthesia reduced surgical bleeding. Blood loss was increased in patients undergoing preoperative hemodilution as compared to thromboprophylaxis with HDHE, whereas no difference was found between conventional administration of dextran and HDHE. Deep vein thrombosis, diagnosed with ascending phlebography of the operated leg, was registered in 48% of the patients. There was no difference between the techniques of anesthesia and thromboprophylaxis. Pulmonary embolism, studied with perfusion-ventilation scintigraphy, was diagnosed in 19% of the patients. No significant difference was found between hypotensive and normotensive anesthesia, or between thromboprophylaxis with conventional dextran and HDHE. There was a lower incidence of pulmonary embolism in patients with HDHE and normotensive anesthesia. Major wound hematomas were noted postoperatively in 12% of the patients receiving HDHE, whereas no major hematomas developed following dextran prophylaxis. No anaphylactic reaction was noted from dextran 70, using hapten-dextran prophylaxis.

Aged↗

Pre- and postoperative levels of antithrombin III with special reference to thromboembolism after total hip replacement.

A prospective study of antithrombin III, determined by electroimmunochemical assay or an amidolytical method, was carried out with special reference to thromboembolism after total hip replacement. Two hundred and seven patients were randomly allocated to thromboembolic prophylaxis with dextran 70 or low dose heparin combined with dihydroergotamine. Deep vein thrombosis determined by phlebography of the operated leg or pulmonary embolism diagnosed with perfusion/ventilation scintigraphy developed in 51% of the total material and did not differ significantly between the two groups of prophylaxis or between patients with a preoperative At III below normal and those with a normal value. The correlation between the two assay methods for At III was 0.61. An initial, postoperative decrease in At III was noted with a parallel fall in hematocrit and fibrinogen, later followed by an increase of the plasma proteins. It is concluded that the immediate postoperative decrease of At III is mostly due to hemodilution.

Antithrombin III↗

Central haemodynamics and regional blood flow during halothane-nitrous oxide anaesthesia and controlled ventilation. An experimental study in the rat.

The haemodynamic effects of halothane-N2O/O2 anaesthesia with controlled ventilation were studied in rats, using the microsphere method. Mean arterial blood pressure was significantly reduced but only minor effects on cardiac output (CO), heart rate, and systemic vascular resistance were seen. During anaesthesia, there were significantly increased fractions of CO delivered to brain, lungs, small intestine and liver (hepatic artery), while the fractions to spleen, stomach and carcass were decreased. Fractional distribution and regional blood flow to heart, kidneys, adrenals and preportal area remained unchanged. When anaesthesia was prolonged from 60 to 90 min, no further changes in central or regional haemodynamics were seen. Considering the minor effects on central haemodynamics and the absence of changes in central and regional haemodynamics at 60 and 90 min, this anaesthesia model should be useful in experimental research.

Anesthesia, General↗

Prevention of dextran-induced anaphylactic reactions by hapten inhibition. I. A Scandinavian multicenter study on the effects of 10 ml dextran 1, 15% administered before dextran 70 or dextran 40.

In an open prospective study the prevention of dextran-induced anaphylactic reactions (DIAR) by hapten inhibition was investigated in 29 252 patients. Forty-nine hospitals in Sweden, Norway and Finland participated in the study which was running for two years. Ten ml of dextran 1, 15%, (Promiten, Pharmacia AB, Uppsala, Sweden) with a weight average molecular weight of 1 000 dalton was injected intravenously two minutes before infusion of dextran 70 (Macrodex) or dextran 40 (Rheomacrodex). DIAR were graded according to severity from I to V. Six grade III and one grade IV reactions occurred, representing an incidence of severe DIAR of 0.024%. Compared to a large historical control material, preinjection of 10 ml of dextran 1 exerts a partially protective effect, but no statistical proof can be given. Consequently trials have been started with a 20 ml dose of dextran 1. Adverse reactions to the preinjection of 10 ml of dextran 1 were observed in 0.072%. These reactions were of a mild and shortlasting nature and considered to be of minor clinical importance.

Adolescent↗

Prevention of dextran-induced anaphylactic reactions by hapten inhibition. II. A comparison of the effects of 20 ml dextran 1, 15%, administered either admixed to or before dextran 70 or dextran 40.

The incidence of dextran-induced anaphylactoid/anaphylactic reactions (DIAR) was investigated after hapten inhibition employing two different modes of administration of dextran 1 (Mw 1 000 dalton). The trial was carried out as an open prospective study that comprised 12 060 patients. They were randomized into two groups--one receiving a mixture of 20 ml dextran 1, 15%, (Promiten) and 500 ml dextran 70 (Macrodex) or dextran 40 (Rheomacrodex) (admixture group), the other receiving an intravenous injection of 20 ml dextran 1, 15% before the infusion of dextran 70 or 40 (preinjection group). DIAR were graded according to severity from I to V. In the admixture group eight DIAR of grade II, one of grade IV and one of grade V were observed, while in the preinjection group two DIAR of grade II occurred. The admixture of dextran 1 to dextran 70 or 40 does not prevent the occurrence of severe DIAR in the dose investigated.

Adolescent↗