Biomedical subjects

C Lund

Publications and source records attributed to C Lund.

102 records · Page 6Linked to original sources

PubMedDate not supplied

Neonatal skin care: the scientific basis for practice.

OBJECTIVE: To review the literature addressing the care of neonatal skin. DATA SOURCES: Computerized searches in MEDLINE and CINAHL, as well as references cited in articles reviewed. Key concepts in the searches included neonatal skin differences; neonatal skin and care practices for skin integrity; neonatal skin and toxicity; permeability; and contact irritant sensitization. STUDY SELECTION: Articles and comprehensive works relevant to key concepts and published after 1963, with an emphasis on new findings from 1993 to 1999. One hundred two citations were identified as useful to this review. DATA EXTRACTION: Data were extracted and organized under the following headings: anatomy and physiology of the skin; physiologic and anatomic differences in neonatal skin; nutritional deficiencies; skin care practices; and care of skin breakdown. DATA SYNTHESIS: Newborns' skin is at risk for disruption of normal barrier function because of trauma. In light of available evidence about differences in neonatal skin development, clinical practice guidelines are suggested for baths, lubrication, antimicrobial skin disinfection, and adhesive removal. In addition, basic care practices are suggested for maintaining skin integrity, reducing exposure to potentially toxic substances, and promoting skin health beyond the neonatal period. Preventive care recommendations are made for reducing trauma, protecting the skin's immature barrier function, and promoting skin integrity. CONCLUSIONS: This review generated evidence with which to create a new and comprehensive practice guideline for clinicians. Evaluation of the guideline is under way at 58 U.S. sites.

Deficiency Diseases↗

PubMedDate not supplied

Cerebral microembolus detection in an unselected acute ischemic stroke population.

OBJECTIVE: The aims of this study were firstly to determine prevalence, frequency, and clinical significance of cerebral microemboli in an unselected acute ischemic stroke population and secondly to examine how this information may improve ischemic stroke subtype classification. METHODS: We intended to perform transcranial Doppler (TCD) microembolus monitorings of the middle cerebral artery (MCA) in the symptomatic hemisphere for 45 min in 120 consecutive patients with internal carotid artery territory ischemia. The first examination was performed within 72 h from start of symptoms and the second 5 +/- 1 days later. Platelet and coagulation system activation were measured following TCD monitoring in 38 patients. The strokes were subtyped using the TOAST classification criteria, and the patients' clinical status was assessed at discharge using the Scandinavian Stroke Scale and the Barthel Index. RESULTS: Microembolus monitoring was technically possible in 83 (69.2%) of the 120 patients. Thirty-two (26.6%) patients had an inadequate temporal bone acoustic window or were too restless to allow long-time monitoring. In 5 (4.2%) patients the relevant MCA was occluded. Twenty-two (26.5%) of the 83 patients had microemboli despite the fact that over 90% were receiving an antiplatelet or an anticoagulant treatment. The mean frequency of microemboli was 6.7 +/- 13.6 per 45 min. Microemboli were more prevalent in assumed cardioembolic stroke than in other subtypes of ischemic stroke (p = 0.047). We found no association between the presence of cerebral microemboli and the clinical outcome or the parameters for platelet or coagulation system activation. The presence of microemboli was not associated with in-hospital deaths (p = 0.17), whereas MCA occlusion was (p = 0.01). CONCLUSIONS: Cerebral microemboli are frequent in unselected acute ischemic stroke patients despite antiplatelet or anticoagulant treatment. TCD detection of microemboli provides valuable pathophysiological information and may, therefore, improve current ischemic stroke subtype classification.

Acute Disease↗

PubMedDate not supplied

Multidisciplinary intensive treatment for chronic low back pain: a randomized, prospective study.

BACKGROUND: Americans with low back pain have been helped to return to work by multidisciplinary intensive treatment programs. Whether this treatment method will succeed in countries with a more generous social welfare system, where the incentive to return to work might be less, is not proven. OBJECTIVES: To evaluate a Danish program of functional restoration combined with behavioral support. METHODS: Patients who had experienced at least 6 months of disabling low back pain were randomly assigned to either a 3-week intensive treatment program (n = 55) or an untreated control group (n = 51). RESULTS: Of the 106 patients randomized, 94 (89%) returned for a 4-month follow-up visit. At that time, 29 (64%) of the 45 treated patients were able to work, compared with 14 of 49 (29%) in the control group. The treated patients had used fewer days of sick leave (P < .02), had contacted health care. professionals fewer times (P < .001), and had lower pain and disability scores. CONCLUSIONS: Although such programs are expensive, they can reduce pension expenditures, sick leave days, health care contacts, and pain.

Activities of Daily Living↗

PubMedDate not supplied

[Reference values of the red blood profile in beagle, German shepherd and golden retriever puppies].

In the present study, blood samples were taken from clinically healthy puppies of the breeds Beagle, German Shepherd, and Golden Retriever between days 1 and 3 (n = 146), 8 and 10 (n = 137), 28 and 33 (n = 151), and 50 and 58 (n = 129) post natum. Measurements for red blood cell count, haemoglobin concentration, haematocrit, mean erythrocyte volume (MCV), mean corpuscular haemoglobin (MCH), and mean corpuscular haemoglobin concentration (MCHC) were performed by a semi-automatic blood cell counter; the normoblast number was counted visually. Between the 1st and 3rd day of life, the erythrocyte number of the puppies was 4.57 +/- 0.68 10(6)/microliter and, as such, was clearly below the reference range for adult animals. It further decreased by the 2nd measurement (8th to 10th day of life) to 3.59 +/- 0.41 10(6)/microliter, and then increased again to 4.75 +/- 0.68 10(6)/microliter (reference range: 3.73-6.25 10(6)/microliter, 2.5% to 97.5% percentile) by the final measurement (50th to 58th day of life). The measurement values of the haemoglobin concentration (13.5 +/- 2.0 g/dl) and haematocrit (41.0 +/- 6.5%) after birth were only insignificantly below or around the lower limit of the reference range for adult animals. Both parameters decreased to a more pronounced extent than did the erythrocyte count. They reached a minimum of 8.4 +/- 1.0 g/dl and 26.8 +/- 3.2%, respectively, between the 28th and 33rd day of life. Even at the end of the examination period (50th to 58th day of life), the values of these parameters (10.1 +/- 1.1 g/dl, reference range: 7.5-11.8 g/dl; 32.1 +/- 4.2%, reference range: 24.8 to 40.8%) were remarkably lower than the minimum of reference range for adult dogs. At the 1st sampling (between 1st and 3rd day of life), MCV (89.8 +/- 6.7 fl) and MCH (29.6 +/- 1.9 pg) were distinctly higher than the reference values for adult dogs. Both parameters decreased with increasing age. Thus, from the 50th-58th day of life, the results were comparable to those of adults. No considerable age dependence was found for MCHC. During the first days of life a relatively high number of normoblasts (8 +/- 7/100 Leukozyten) was found; it decreased rapidly. The study revealed significant differences between the breeds, e.g. German Shepherd dogs had lower initial values of erythrocyte count, haemoglobin concentration, and haematocrit when compared to the other breeds. Puppies of this breed also had higher normoblast numbers than the Beagle and Golden Retriever puppies at the 2nd and 3rd samplings. No clear sex differences in the studied parameters were observed. The results of this study reflect the replacement of fetal erythrocytes by postnatal erythrocytes. Moreover, they illustrate the need to use age as well as breed-specific reference ranges.

Aging↗

PubMedDate not supplied

The effect of subarachnoid lidocaine and combined subarachnoid lidocaine and epidural bupivacaine on electrical sensory thresholds.

Eight patients undergoing abdominal surgery received a combination of spinal anesthesia (catheter at L2-3 level) and epidural anesthesia (catheter at T10-11 level). Sensory thresholds to electrical stimulation were measured at the S1, L1, T10, and T5 levels before injection, after spinal anesthesia, and after the addition of epidural anesthesia. Subarachnoid injections with 5% lidocaine (without dextrose) were given until a T4 sensory level to pinprick was obtained (mean dose, 175 mg lidocaine). The mean sensory thresholds were increased from 2.2 +/- 0.3, 2.4 +/- 0.4, 2.9 +/- 0.4, and 3.8 +/- 0.4 mA to 21.3 +/- 4.3, 13.3 +/- 4.9, 10 +/- 4.4, and 10.6 +/- 4.3 mA, respectively (p less than 0.05 at all levels). The addition of 5 ml 0.5% epidural bupivacaine further increased the mean sensory thresholds to 26.9 +/- 3.1, 21.7 +/- 4.1, 21.3 +/- 4.1, and 17.5 +/- 4.7 mA, respectively (p less than 0.05 at all levels). Combined subarachnoid and epidural local anesthetics provide an enhanced afferent block not obtainable by either technique alone.

Aged↗

PubMedDate not supplied

Effects of etidocaine administered epidurally on changes in somatosensory evoked potentials after dermatomal stimulation.

The effect of lumbar epidural anesthesia with similar volumes (approximately 20 ml) of 1% and 1.5% etidocaine on early (less than 0.5 seconds) somatosensory evoked potentials (SEPs) to electrical stimulation of the S1, L1, and T10 dermatomes was examined in two groups of ten patients in a randomized, double-blind study. Level of analgesia to pinprick was T7.7 +/- 0.9 in the 1% group and T6.6 +/- 0.6 in the 1.5% group and all patients had total motor block. Despite similar analgesia to pinprick, SEP amplitude was more reduced in the 1.5% group, in which SEPs were abolished in all patients at the L1 level.

Adult↗

PubMedDate not supplied

Effect of thoracic epidural bupivacaine 0.75% on somatosensory evoked potentials after dermatomal stimulation.

The effect of thoracic epidural bupivacaine 0.75%, 9 ml, on early (less than 500 ms) somatosensory evoked potentials (SEPs) during electrical stimulation of the T10 and L1 dermatomes was examined in ten patients. Spread of analgesia (pinprick) was T3.7 +/- 0.5 to L2.5 +/- 1 (mean +/- SEM). Peak-to-peak amplitudes of the T10 SEPs were reduced (p less than 0.05) while an insignificant reduction was found in L1 stimulated potentials. SEPs were abolished in four and two patients at the T10 and L1 levels, respectively. The latency of the early SEP components (0, P1-3, N1-3) increased (p less than 0.05) at T10 but was not significant at L1 except for N2 and N3. Sensory threshold increased significantly in both stimulation areas during blockade. In conclusion, thoracic epidural administration of 9 ml of bupivacaine 0.75% does not provide total afferent somatic blockade despite sensory analgesia to pinprick.

Adult↗

PubMedDate not supplied

Dressing change core procedure: a new approach.

The dressing change core procedure has proven advantageous to our clinical staff. It has enhanced the quality of wound care because it is comprehensive, eliminating the need to look up several procedures. Wound care strategies involving new products are readily incorporated as addendums to the core procedure. Additionally, staff and students with varying levels of education and experience can understand the core procedure and apply it to their clinical practice settings. The "core" concept has made the dressing procedure one of the highlights of our skin care program.

Bandages↗

PubMedDate not supplied

Effect of epidural 0.25% bupivacaine on somatosensory evoked potentials to dermatomal stimulation.

The effect of lumbar epidural analgesia with similar volumes (about 25 ml) of 0.25% and 0.5% bupivacaine on early (less than 0.5 seconds) somatosensory evoked potentials (SEPs) to electrical stimulation of the S1, L1, and T10 dermatomes was examined in two groups of ten patients. Level of sensory analgesia to pinprick was T5.7 +/- 0.8 and T6.4 +/- 0.7 in the 0.25% and 0.5% bupivacaine group, respectively. Motor blockade was more pronounced in the 0.5% bupivacaine group (p less than 0.05). Despite similar analgesia to pinprick, SEPs were more reduced during 0.5% bupivacaine than during 0.25%. These results support previous findings that quantitative assessment of neural blockade by SEP measurements may be more precise than pinprick analgesia.

Adult↗

PubMedDate not supplied

Determination and depletion of residues of carbadox, tylosin, and virginiamycin in kidney, liver, and muscle of pigs in feeding experiments.

The results of residue determinations of the growth promotors carbadox, tylosin, and virginiamycin in kidney, liver, and muscle from pigs in feeding experiments are described as well as the analytical methods used. Residues of the carbadox metabolite quinoxaline-2-carboxylic acid were found in liver from pigs fed 20 mg/kg in the diet with a withdrawal time of 30 days. No residues were detected in muscle with zero withdrawal time. The limit of determination was 0.01 mg/kg for both tissues. No residues of virginiamycin and tylosin were found in pigs fed 50 and 40 mg/kg, respectively, in the diet, even with zero withdrawal time. Residues of tylosin of 0.06 mg/kg and below were detected in liver and kidney from pigs fed 200 or 400 mg/kg and slaughtered within 3 h after the last feeding.

Animals↗

PubMedDate not supplied

The value of provoked expectoration in obtaining sputum samples for cytologic investigation. A prospective, consecutive and controlled investigation of 134 patients.

A prospective controlled investigation in 134 consecutive outpatients compared the cytologic adequacy of sputum samples obtained by spontaneous and provoked expectoration. Inhalation of nebulized 10% sodium chloride was used for provoked expectoration. A significantly higher number of adequate samples was produced after provocation, as judged by the presence of alveolar macrophages (X2 = 5.63; p less than 0.02). The improvement in sample adequacy was limited to the nonsmokers and ex-smokers in the study. This result, together with the relatively high cost of cytologic sputum examinations, indicates that provoked expectoration should at least be applied to the collection of sputum samples from nonsmokers and ex-smokers.

Humans↗

PubMedDate not supplied

Analgesic effect of incisional morphine following inguinal herniotomy under spinal anesthesia.

BACKGROUND AND OBJECTIVES: Opioids have been shown to possess antinociceptive effects after peripheral administration in experimental and clinical studies. The results of clinical studies on intra-articularly administered morphine are, however, conflicting. The objective of this study was to examine a possible analgesic effect of incisionally administered morphine on postoperative pain in patients undergoing inguinal herniotomy. METHODS: Forty outpatients were included in a double blind randomized, placebo-controlled study. The patients had spinal anesthesia with 1.5-2.0 mL hyperbaric 5% lidocaine. At conclusion of herniotomy morphine 5 mg was injected incisionally in 10 patients, intravenously in 10, and subcutaneously in 10. The placebo group of 10 patients had saline injected in the incision. Postoperative pain was assessed with a visual analog scale at rest and during mobilization. Assessments were made immediately before and at 0, 2, 4, and 6 hours after herniotomy and on the second and seventh postoperative days. At the same times morphine and acetaminophen consumptions were recorded. RESULTS: There were no significant differences in postoperative visual analog scores between the groups. Except for the cumulative morphine requirement from the second to the seventh postoperative day, which was significantly higher in the placebo group than in other groups, no significant differences in cumulative morphine and acetaminophen requirements were found between the groups. CONCLUSIONS: A single 5-mg dose of morphine injected in the herniotomy wound did not affect pain scores or supplementary analgesic requirements, which argues against a role of peripheral opioid receptors in mediating analgesia.

Acetaminophen↗