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Biomedical subjects

D Selander

Publications and source records attributed to D Selander.

At least 19 recordsLinked to original sources
PubMed2000

Gene therapy for pediatric AIDS.

Gene therapy is an experimental treatment modality under investigation for applications to HIV-1 infection. We have developed retroviral vectors carrying anti-HIV-1 genes, demonstrated that these genes cause significant suppression of HIV-1 replication in cultures of primary hematopoietic cells, and performed a clinical trial in pediatric AIDS patients. Four HIV-1-infected children and adolescents underwent bone marrow harvest from which CD34+ cells were isolated and transduced by a retroviral vector carrying an RRE decoy gene. The cells were re-infused into the subjects, without complications, showing that gene transfer in pediatric AIDS patients in safe and feasible. However, gene-containing leukocytes in the peripheral blood were seen only at a low level and only in the first months following cell infusion. To attain some degree of efficacy, it will be necessary to achieve a higher level of gene transfer and to obtain sustained gene expression. We are currently developing new gene transfer methods and vectors designed to improve the results in future trials. If it becomes possible to reach the ideal goal of producing high percentages of T lymphocytes and monocytic cells that are resistant to HIV-1 infection, gene therapy could serve as a complement to antiretroviral drug therapy and help to sustain immunologic function.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Axillary brachial plexus block with ropivacaine 7.5 mg/ml. A comparative study with bupivacaine 5 mg/ml.

BACKGROUND: Ropivacaine is less cardiotoxic than bupivacaine and may be used in higher doses in order to increase the quality of a block. The aim of this study was to compare the efficacy and safety of 40 ml ropivacaine 7.5 mg/ml (300 mg) and 40 ml bupivacaine 5 mg/ml (200 mg) for axillary plexus block. METHODS: One hundred and four adult patients were included in a prospective, double-blind study. Sensory and motor block were tested for the five main terminal nerves of the arm at 10-min intervals until start of surgery and every second hour there-after until full resolution of the block. RESULTS: The overall evaluation of the block by the surgeon and the anesthesiologist showed a significantly better quality in the ropivacaine patients, regarding both anesthesia and motor block. There were no differences in the time to onset and duration of the block. Except for one patient, who had seizures after an accidental IV injection of ropivacaine, there were no major side effects. CONCLUSION: Ropivacaine 7.5 mg/ml, 40 ml, produces axillary plexus block of similar onset and duration but better quality than 40 ml of bupivacaine 5.0 mg/ml.

Adult↗
PubMed1998

Neonatal outcome and mode of delivery after epidural analgesia for labour with ropivacaine and bupivacaine: a prospective meta-analysis.

In this prospective meta-analysis, we have evaluated the effect of epidural analgesia with ropivacaine for pain in labour on neonatal outcome and mode of delivery compared with bupivacaine. In six randomized, double-blind studies, 403 labouring women, primigravidae and multiparae, received epidural analgesia with ropivacaine or bupivacaine 2.5 mg ml-1. The drugs were administered as intermittent boluses in four studies and by continuous infusion in two. Apgar scores, neurological and adaptive capacity scores (NACS), degree of motor block and mode of delivery were recorded. The studies were designed prospectively to fit meta-analysis of the pooled results. Results showed similar pain relief and consumption of the two drugs. In the vaginally delivered neonates, NACS scores were approximately equal for both groups at 2 h, but at 24 h there were fewer infants with NACS less than 35 in the ropivacaine compared with the bupivacaine group (2.8% vs 7.6%; P < 0.05). Spontaneous vaginal deliveries occurred more frequently overall with ropivacaine than with bupivacaine (58% vs 49%; P < 0.05) and instrumental deliveries (forceps and vacuum extraction) less frequently (27% vs 40%; P < 0.01), while the frequency of Caesarean section was similar between groups. The intensity of motor block was lower with ropivacaine. There were no significant differences in adverse events.

Adolescent↗
PubMed1991

Baricity and the distribution of lidocaine in a spinal canal model.

The role of the baricity of local anaesthetic solutions in determining the distribution of local anaesthetics injected into the subarachnoid space (and hence the level of anaesthesia) has been challenged. A recent study found no difference in the extent of cephalad spread of hyperbaric and isobaric solutions and concluded that density had no effect on the spread of local anesthetics. The present study, to determine the validity of this conclusion, utilized a spinal model filled with a "cerebrospinal fluid equivalent." Following the injection of hyperbaric lidocaine, the local anaesthetic was most concentrated at the lower end of the column, whereas following the injection of isobaric solution the local anaesthetic was most concentrated around the site of injection. Therefore, baricity is an important determinant of local anaesthetic distribution in the subarachnoid space.

Atmospheric Pressure↗
PubMed1985

Adrenergic vasoconstriction in peripheral nerves of the rabbit.

The blood flow in the sciatic nerve of the rabbit was estimated from the wash out of intraneurally injected 133Xe. To avoid diffusion of the tracer into the surrounding muscular tissue, the nerve was covered by a gas-tight plastic film. Using this technique, the basal blood flow in the sciatic nerve was estimated to 35 ml X min-1 X 100 g-1. It was found that intraarterial norepinephrine and electrical stimulation of the lumbar sympathetic chain strongly reduced the wash out of 133Xe, which only can be explained by a pronounced reduction of the blood flow in the nerve itself. The blood flow again increased within 4 min of stopping the infusion of norepinephrine or the sympathetic stimulation. The prolonged effect and higher neurotoxicity of local anesthetics containing adrenaline may be explained by an alpha receptor-mediated vasoconstriction of the microvessels of peripheral nerves.

Animals↗
PubMed1984

Intratumor distribution of capillary permeability surface area product (PS) correlated to tumor vascular space and blood flow.

The intratumor distribution of the capillary permeability surface area product (PS) correlated to the intratumor distribution of vascular space and of blood flow was studied by labeled albumin in a transplantable rat fibrosarcoma. A wide heterogeneity in intratumor distribution of PS was found. The tumor PS values were not significantly correlated to tumor vascular space or to blood flow values. This might suggest that intravascularly administered drugs could reach a comparative high intratissue concentration also in less vascularized tumor areas.

Albumins↗
PubMed1981

Local discomfort and thrombophlebitis following intravenous injection of diazepam. A comparison between a glycoferol-water solution and a lipid emulsion.

Diazepam is frequently used for pre- and peroperative sedation. However, at i.v. injection local pain and thrombophlebitis are not uncommon, probably due to tissue irritancy of the various organic solvents necessary to keep diazepam in aqueous solution. In this study the incidence of local adverse effects following i.v. injection of Diazemuls, a new lipid emulsion formulation, was compared with that of Apozepam, a glycoferol-water solution. We found that the latter preparation caused local pain and thrombophlebitis as often as reported with propyleneglycol-phenylcarbinol-ethanol preparations (Stesolid, Valium) and in a statistically higher incidence that the lipid emulsion form, which therefore seems more suitable for intravenous use.

Adult↗
PubMed1980

Hemoperfusion with Amberlite resin in the treatment of self-poisoning.

Ten patients with various intoxications were treated with resin hemoperfusion. Three of four patients with grade IV coma due to tricyclic antidepressant (TCA) poisoning could be extubated during or on termination of hemoperfusion. Clearance values of 135--185 and 190--200 ml/min were obtained for amitriptyline and nortriptyline, respectively. One patient with severe chloral hydrate poisoning could be extubated after less than one hour's hemoperfusion. A clearance of 140 ml/min was obtained in a uremic patient with AV block II due to digitoxin intoxication. Four patients with mushroom poisoning were treated with combined hemoperfusion-hemodialysis. A transient fall in platelet count was seen in all patients. Resin hemoperfusion is of definite value in selected, severe cases of self-poisoning with psychotropic drugs such as TCA and possibly in cases of mushroom poisoning where the prognosis with hemodialysis and supportive therapy is doubtful.

Adult↗
PubMed1979

Self-poisoning treated in the ICU.

This retrospective study compares number and type of self-poisonings admitted to the intensive care units (ICU) at Sahlgren's Hospital, Gothenburg, during 1972 and 1976. The total number of patients requiring intensive care was unchanged, but a change in the pattern of self-poisoning was seen. In 1976 the number of patients requiring intensive care following acute alcohol intoxication had increased, whereas the number of barbiturate and methaqualone poisonings decreased. Tricyclic antidepressants formed the largest group in both years. Fewer patients needed endotracheal intubation and IPPV in 1976 than in 1972. Also, fewer complications were seen, and the death rate among ICU-treated patients decreased. In the Gothenburg area barbiturates accounted for one half of all deaths due to self-poisoning and tricyclic antidepressants for one fifth. Any expected decrease in intensive care as a result of fewer barbiturate and methaqualone poisonings was obscured by an increase in severe alcohol intoxication.

Alcoholic Intoxication↗
PubMed1979

Paresthesiae or no paresthesiae? Nerve lesions after axillary blocks.

Seeking paresthesiae when performing a peripheral nerve block may increase the risk of post-anesthetic neurological sequelae. To test this hypothesis, we prospectively followed two groups of patients who underwent hand surgery with an axillary block. In one group, the axillary plexus was located by actively seeking paresthesiae; in the other, pulsations of the axillary artery indicated an adequate position of the injection needle. Mepivacaine 10 mg/ml, with or without adrenaline, was used. The study included 533 patients, 290 in the paresthesia group and 243 in the artery group. Although unintentional, paresthesiae were elicited in 40% of patients in the artery group. Postanesthetic nerve lesions were seen in ten patients, eight in the paresthesia group and two in the artery group, all of whom had been blocked by mepivacaine with adrenaline. Symptoms varied between light paresthesiae lasting a few weeks, and severe paresthesiae, ache and paresis lasting more than 1 year. The etiology suspected was needle and perhaps injection trauma to the nerves during blocking. We conclude that whenever possible nerve blocks should be performed without searching for paresthesiae.

Adult↗
PubMed1979

Local anesthetics: importance of mode of application, concentration and adrenaline for the appearance of nerve lesions. An experimental study of axonal degeneration and barrier damage after intrafascicular injection or topical application of bupivacaine (Marcain).

Local anesthetics are designed for application in or close to nerve tissue. In spite of their wide clinical use, surprisingly few investigations deal with the neural toxicity of modern local anesthetics. In this experimental study, the effects were investigated of intrafascicular or topical application of the long-acting local anesthetic bupivacaine on the rabbit sciatic nerve. Axonal degeneration was histologically evaluated and a fluorescence-microscopic technique used to detect lesions in the blood-nerve barrier. Topical application of bupivacaine in clinically recommended concentrations around the nerve caused no detectable nerve injury, while intrafascicular injections caused considerable axonal degeneration and damaged the blood nerve barrier. Axonal degeneration was the same after injection of physiologic saline solution and bupivacaine 0.5%, but it increased with increasing bupivacaine concentration and especially with the addition of adrenaline. On the other hand, the acute effects of intrafascicular injection, as visualized in the barrier experiments, changed little with the addition of adrenaline, indicating that it is the injection trauma itself which is deleterious. It is concluded that intraneural injections should be avoided and that plain bupivacaine solutions should be routinely used.

Administration, Topical↗