Biomedical subjects

E Fosse

Publications and source records attributed to E Fosse.

At least 19 recordsLinked to original sources

PubMed1992

[Traumatic pneumopericardium with cardiac tamponade].

A 20 year old male motorist with multiple injuries, including bilateral lung laceration, developed cardiac tamponade 12 hours after injury. X-ray showed characteristic findings of pneumopericardium with air all around the cardiac silhouette, which was diminished in size. A chest tube was inserted intrapericardially through a subxiphoid incision. Blood pressure increased immediately, and central venous pressure became normal. Cardiac left ventricular stroke work increased by 86% to normal value. The drain was removed after three days. Another patient was a 15 year old male cyclist who had been overrun by a trailer. Left-sided emergency thoracotomy was performed during laparotomy for liver and vena cava injury, in the course of which procedures there was a sudden decrease in blood pressure with marked elevation of the central venous pressure. The pericardium was incised. Air hissed out, leading to normalisation of arterial and venous pressures. Both patients recovered. Pneumopericardium without symptoms may be treated by observation. Tension pneumopericardium is rare and is best treated by open drainage.

Accidents, Traffic↗

PubMed1992

Time for new concepts about measurement of complement activation by cardiopulmonary bypass?

Fifty-one patients admitted for routine coronary bypass operations were randomized to cardiopulmonary bypass with a membrane oxygenator (Capiox) or a bubbler (Polystan or William Harvey). Complement activation was measured using enzyme immunoassays for concentrations of C3 activation products and the terminal complement complex. From 5.8 to 8.1 arbitrary units (AU)/mL (medians), the plasma concentrations of C3 activation products increased by 119.9 AU/mL (Capiox), 124.6 AU/mL (Polystan), and 79.5 AU/mL (William Harvey) to a peak at closure of the sternum (not significant when related to baseline concentrations). The increase in C3 activation products and baseline C3 activation were linearly correlated (R2 = 0.30; p less than 0.0001). From 5.5 to 6.1 AU/mL, the plasma terminal complement complex concentrations increased by 45.2 AU/mL (Capiox), 15.4 AU/mL (Polystan), and 17.4 AU/mL (William Harvey) to a peak before termination of cardiopulmonary bypass. Maximal terminal (C5-C9) activation was significantly higher in the membrane oxygenator group (p less than 0.0001) and showed no relationship to C3 activation. Measurement of C3 activation only gives no information about C5-C9 activation. At present, terminal complement complex quantitation is probably the best index of C5-C9 activation during cardiopulmonary bypass.

Cardiopulmonary Bypass↗

PubMed1992

Surgery in Afghanistan: a light model for field surgery during war.

Owing to a poor capability for evacuation, mobile medical teams were sent to the area of Gazni in Afghanistan to work with local paramedics as part of a medical programme for the area. The teams were equipped to perform major surgery. During 1 month a surgical team inside Afghanistan performed 53 operations. The operations were performed in the patients' homes at night. The team had to move frequently so as not to be spotted by the Soviet and government surveillance. Equipment equivalent to a light field hospital was stored in a safe place and the team carried supplies for 1 or 2 days on their bicycles. One postoperative death and one wound infection were recorded. It is concluded that adequate surgery can be performed inside territories where enemy forces have air control and under primitive conditions with an acceptable rate of complications. However, due to the nature of the guerrilla warfare with scattered military confrontations over vast areas, the average time between injury and treatment for war casualties was 36 h.

Adolescent↗

PubMed1992

Reduced complement activation with heparin-coated oxygenator and tubings in coronary bypass operations.

Complement activation after cardiopulmonary bypass is correlated with postoperative organ dysfunction. Heparin coating of the entire blood-contact surface of the cardiopulmonary bypass circuit has proved to reduce complement activation in vitro. A membrane oxygenator and tubing setup coated with functionally active heparin was compared with an uncoated, otherwise identical setup in 20 patients undergoing routine coronary bypass operations. The concentrations of C3 activation products and the terminal complement complex were measured in sensitive and specific enzyme immunoassays. Peak concentrations of C3 activation products were 90.1 (74.7 to 107.4) AU/ml (medians and 95% confidence intervals) and 52.4 (35.7 to 76.4) AU/ml with the uncoated and coated setups, respectively (p = 0.02). The corresponding concentrations of the terminal complement complex were 26.2 (20.1 to 37.5) AU/ml and 13.7 (11.1 to 25.1) AU/ml (p = 0.03). Blood loss from the mediastinal drains during the first 12 postoperative hours was 533 (416 to 975) ml in patients treated with the uncoated setup and 388 (313 to 579) ml in the coated treatment group (p = 0.06) and was significantly correlated with peak concentrations of the terminal complement complex (p = 0.01). There were no differences in neutrophil counts nor platelet numbers between the treatment groups. The approximate 45% reduction in complement activation with the heparin-coated cardiopulmonary bypass device indicates a substantial improvement of biocompatibility.

Aged↗

PubMed1991

[Emergency thoracotomy. Aortic clamping in major bleeding].

Emergency room thoracotomy was performed in 22 cases. 19 of the patients were admitted following injury. Four of the injured patients survived. Two of the survivors had penetrating injury above the diaphragm, one had penetrating injury below the diaphragm. One survivor had blunt injury to the abdominal vena cava and the liver. There was no difference between the group of patients that survived and the group that died as regards probability of survival estimated by the TRISS method, trauma score and injury severity score. Internal heart compression was performed in nine cases. Emergency room thoracotomy is a life-saving procedure in critically unstable patients.

Adolescent↗

PubMed1991

[Decortication of the lung].

During a six year period 18 patients were operated by decortication of the lung. Eight patients had empyema, five were decorticated for postoperative/posttraumatic formation of haematoma. Four patients had restrictive pleuritis and one patient was operated due to insufficient expansion of the lung after operation for emphysematous bullae. After the decortication, one patient developed empyema and one septicemia, but both these patients were treated successfully. The median postoperative stay in hospital was 13 (7-84) days. Decortication should be considered for patients with empyema or pleural haematoma if the pleural effusion persists after more than one week of adequate drainage.

Adult↗

PubMed1991

[Surgical pleurodesis in spontaneous pneumothorax].

Over a five year period 41 operations for spontaneous pneumothorax were performed on 38 patients. In all cases a transaxillary thoracotomy was performed in the third, or in some cases the fourth, intercostal space. Bullae were resected and operative pleurodesis carried out by rubbing the parietal pleura with a dry sponge. The indications for operation were: 1) More than one episode of pneumothorax on the relevant side. 2) The first incidence of pneumothorax if the patient had pneumothorax on the contralateral side before. 3) Continuous leakage of air after a week of drainage. One patient had to be reoperated for recurrence of pneumothorax, and one was reoperated due to formation of a large postoperative haematoma. One patient developed paresis of the serratus anterior muscle due to lesion of the long thoracic nerve.

Adolescent↗

PubMed1991

Complement activation and bioincompatibility. The terminal complement complex for evaluation and surface modification with heparin for improvement of biomaterials.

The degree of biocompatibility of biomaterials can be evaluated using various assay systems detecting activation of the blood cascade systems, leukocytes or platelets. Activation of complement is one mechanism associated with adverse effects observed when bioincompatible materials are used. We present data showing that the terminal complement complex, an indicator of terminal pathway activation, is suitable for evaluation of biocompatibility of biomaterials such as cardiopulmonary bypass devices. Furthermore, our results suggest that bioincompatibility is improved when artificial surfaces are modified with end point attached functionally active heparin.

Complement Activation↗

PubMed1990

[Fluid therapy changes in surgical treatment of abdominal aortic aneurysm].

The use of blood components and blood substitutes was studied in 25 patients undergoing surgical treatment for abdominal aortic aneurysm in 1983, and was compared with the use of such components in 44 patients operated in 1988. The use of blood components had decreased by 49% from 1983 to 1988. In 1988, erythrocytes were administered only when the hemoglobin concentration fell under 9 g/100 ml. The use of plasma postoperatively was reduced to a minimum. Normovolemia was maintained with polygeline, dextran, electrolytes and autotransfusion. The change in transfusion praxis did not lead to any reduction in postoperative hemoglobin values. The stay in hospital and the number of hours spent in a respirator were both reduced, and there was a general improvement in results.

Aorta, Abdominal↗

PubMed1990

[Blood transfusion in heart surgery].

We have studied the effect of blood-saving measures in open heart surgery. Such measures were introduced in 1987. All fluids administered on the day of operation and on the first postoperative day were registered in all cardiac patients operated during one month in 1986, 1987, 1988. In 1986 the patients were exposed to a median of 21 donors while in 1988 they were exposed to a median of 2 donors. The reduction in transfusions was achieved by substituting plasma by polygeline, by giving thrombocytes only when there was a low thrombocyte count and by accepting a hemoglobin value of 9 g/100 ml before transfusion of erythrocytes. In 1988 most postoperatively drained blood was retransfused using a Sorensen retransfusion set. The reduction in transfusions has reduced the cost of each open heart operation by NOK 11,662.

Blood Donors↗

PubMed1990

Complement activation with bubble and membrane oxygenators in aortocoronary bypass grafting.

Thirty-three patients admitted for coronary bypass grafting were randomized to cardiopulmonary bypass with a bubble oxygenator (Cobe or Polystan) or a membrane oxygenator (SciMed). Plasma concentrations of C3 activation products and the terminal complement complex were measured using enzyme immunoassays. Both variables increased almost linearly after onset of cardiopulmonary bypass, with maximal concentrations at closure of the sternum. From a baseline of 7.5 to 12.0 arbitrary units (AU)/mL (medians), the concentrations of C3 activation products increased by 117.5 AU/mL (Cobe), 120.5 AU/mL (Polystan), and 213.3 AU/mL (SciMed). The increase in the membrane group was significantly higher than in the two bubble oxygenator groups (p less than 0.01). From a baseline of 0.9 to 1.3 AU/mL, the concentrations of terminal complement complex increased by 5.4 AU/mL (Cobe), 6.6 AU/mL (Polystan), and 7.7 AU/mL (SciMed) (differences not significant). The higher C3 activation caused by the membrane oxygenator may be explained by differences in flow profile and surface area in contact with blood. The study cannot confirm the general assumption that membrane oxygenators lead to lower complement activation than do bubble oxygenators.

Aged↗

PubMed1989

Human immunodeficiency virus and hepatitis B virus in injured patients and victims of violence.

Of a total number of 643 injured patients admitted during 1986 and 1987, 113 were tested for antibodies against the human immunodeficiency virus (HIV) and hepatitis B surface antigen HBsAg and the concentration of hepatitis B surface antibodies (HBsAb) was determined. Nine patients were HIV positive while HBsAg was detected in two patients and increased levels of HBsAb were found in 19 patients. HIV antibodies were found in 6 (4.8 per cent) of 124 victims of violence, in 3.3 per cent of the patients with penetrating injuries and 1.1 per cent of the patients with multiple, closed injuries. The estimated prevalence for HIV infection in the Norwegian population is 0.08 per cent, thus indicating an over-representation of infected patients among injured patients and victims of violence.

Emergencies↗

PubMed1989

Different oxygenators for cardiopulmonary bypass lead to varying degrees of human complement activation in vitro.

Complement activation was studied in vitro with six different membrane and bubble oxygenators for cardiopulmonary bypass. There was a similar increase in terminal (C5 to C9) activation with all oxygenators (p less than 0.001), ranging from 281% (117% to 444%) to 453% (225% to 680%) after 60 minutes (median and 95% confidence intervals). C3 activation was not observed with a hollow fiber membrane and a soft shell bubble oxygenator. On the other hand, a capillary membrane, a sheet membrane, a nonporous membrane, and a hard shell bubble oxygenator all induced a similar increase in C3 activation (p less than 0.01), ranging from 107% (23% to 346%) to 272% (88% to 395%) after 60 minutes. The differences in C3 activation could not be explained by the blood contact materials or any other single factor known to induce activation, which suggests that overall complement activation during cardiopulmonary bypass is a multifactorial effect. The tubing set per se induced only minor C3 activation but contributed to the overall formation of terminal complement complex. The study further indicates that an arterial line blood filter prevents activated neutrophils from being reinfused to the patient and should be used regardless of type of oxygenator.

Cardiopulmonary Bypass↗

PubMed1988

The siege of Tripoli 1983: war surgery in Lebanon.

When Syrian-backed troops attacked the city of Tripoli and the surrounding Palestinian refugee camps in November and December 1983, the authors worked in the Palestine Red Crescent Society (PRCS) Hospital in the area. The hospital was situated close to the front line of the battle at all times and the transportation of casualties was therefore short. During the first month of the battle this hospital received approximately 1,500 casualties, and 390 primary and 24 secondary operations were performed. Multiple shrapnel wounds dominated, and high-velocity missile wounds were also frequently seen. The common treatment principles for missile wounds with radical debridement and delayed primary suture, in some cases secondary suture, were followed. Exploratory surgery was carried out in cases of suspected intra-abdominal and vascular injuries. Limited resources made an efficient selection necessary. Surgery under conditions of war is extremely demanding upon resources: equipment and personnel. By leaving minor debridements and a large amount of the emergency treatment to experienced nurses, a high capacity could be maintained.

Emergency Medical Services↗

PubMed1988

Complement activation by extracorporeal circulation: effects of precoating a membrane oxygenator circuit with human whole blood.

In an in vitro study of extracorporeal circulation (ECC), uncoated oxygenators (UC), oxygenators precoated with whole human blood (CN) and oxygenators precoated with blood and then rinsed with Ringer's acetate (CR) all significantly (p less than 0.001) activated the initial and terminal parts of the complement cascade. After 60 min C3 activation had increased by 692% (UC), 750% (CN) and 393% (CR), and terminal complement complex (TCC) concentrations by 194% (UC), 215% (CN) and 273% (CR). C3 activation was significantly (p less than 0.05) less in the CR than in the other groups. There was no statistical intergroup difference in increase of TCC concentration. Complement activation was accompanied by a significant drop in neutrophil counts, which was uninfluenced by coating or rinsing. The observed dissociation of the complement cascade shows that assessment of activation products from both parts is necessary for evaluation of total complement activation. The study suggests that protein precoating may improve biocompatibility of ECC.

Biocompatible Materials↗

PubMed1987

Alterations in T-helper and T-suppressor lymphocyte populations after multiple injuries.

Fifteen patients with multiple injuries and an Injury Severity Score (ISS) ranging from 2 to 57 (median 25) were studied for variations in lymphocyte populations on the day of injury and the three following days. Nine of the patients had an ISS above 16. In all patients the total number of lymphocytes fell during the first 24 hours after the injury (P less than 0.01), mainly due to a reduction in the number of circulating T-lymphocytes from a median of 1.8 to 0.6 x 10(9) cells/l (P less than 0.01). No reduction in the T-helper/T-suppressor cell ratio could be demonstrated for the group as a whole, but in the 9 patients with an Injury Severity Score (ISS) of more than 16 a significant reduction in ratio from median 1.5 to 0.8 was found. Due to clinical observations patients with an ISS of more than 16 are considered severely injured and at risk of developing complications such as infection and septicaemia. The fall in T-helper/T-suppressor ratio indicates impaired immunity in these patients.

Adolescent↗

PubMed1987

Granulocytes in bronchial lavage fluid after major vascular surgery.

Increased numbers of polymorphonuclear granulocytes (PMN) in the airways, as measured by PMN content in bronchial lavage fluid (P less than 0.01), were found 3 h postoperatively in ten patients undergoing surgery for lumbar aortic aneurysms. An increase in plasma levels of the complement split product C3dg from 6 (0-19) AU/ml preoperatively to 20 (13-50) AU/ml 3 h after surgery (P less than 0.01), indicates an activation of the complement cascade. These changes were not accompanied by increased elastase activity in the bronchial lavage fluid or by major changes in pulmonary blood gas exchange or vascular resistance, indicating that massive PMN activation, analogous to that proposed in adult respiratory distress syndrome (ARDS) had not taken place. In conclusion, complement system activation and migration of PMN into the airways, as seen in connection with major vascular surgery, does not seem to contribute to ARDS-type pulmonary dysfunction.

Aged↗

PubMed1987

Effects of methylprednisolone on complement activation and leukocyte counts during cardiopulmonary bypass.

Generation of the complement activation products C3dg and terminal complement complex (TCC) and numerical changes in peripheral granulocytes (PMN) and lymphocytes were assessed in patients undergoing aortocoronary bypass surgery with extracorporeal circulation (ECC). Fluid from bronchial lavage performed preoperatively and 4 hours postoperatively was analyzed for granulocyte elastase activity and PMN content. Ten of the 20 patients received methylprednisolone (30 mg/kg b.w.) immediately before ECC. No difference was found between them and the control group regarding C3dg and TCC, and both groups showed similar postoperative decrease of peripheral blood lymphocytes. The postoperative PMN count in peripheral blood was significantly higher in the methylprednisolone group than in the controls from 12 hours onwards. In bronchial lavage fluid the postoperative PMN count was unaltered in the methylprednisolone group, but significantly increased in the controls. No granulocyte elastase activity was found before or after surgery in either group. The results indicated that methylprednisolone does not affect complement activation during cardiopulmonary bypass, but increases the granulocytes in peripheral blood postoperatively.

Adult↗