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Biomedical subjects

G Blennow

Publications and source records attributed to G Blennow.

At least 73 records · Page 4Linked to original sources

Adverse effects from the circadian fluctuations of carbamazepine plasma levels.

In children on carbamazepine therapy who were complaining of tiredness it was proposed that the considerable plasma drug level variation over the day could explain this side effect. In spite of a "normal" fasting level the plasma drug level 2-4 hours after drug intake was well above the upper recommended therapeutic level. It is recommended that the time of sampling should be taken into account in carbamazepine drug monitoring.

Adolescent↗

Gliomas of the anterior visual pathway in children. Tumour behaviour and effect of treatment.

An analysis of 16 cases of optic glioma in childhood is presented. All tumours were astrocytomas of the juvenile pilocytic of type low malignancy. In 7 of 13 patients with involvement of the chiasm there was a significant progression of tumour during the follow-up period, including 4 cases with fatal outcome. Patients under 5 years of age had a more unfavourable course than older children, but at the same time they had received lower doses of radiotherapy. The 5 patients treated with an absorbed dose of 39 Gy or more are alive without signs of progression 7-20 years after treatment. It is concluded from this material and from a survey of literature that many cases of optic glioma in childhood do not have a benign course. Guidelines for treatment are proposed.

Adolescent↗

Malignant hyperthermia in a myopathic child. Prolonged postoperative course requiring dantrolene.

An 18-month-old boy with congenital muscular dystrophy began to develop clear signs of the malignant hyperthermia syndrome after 85 min of halothane/nitrous oxide anaesthesia. Dantrolene, 2 mg/kg i.v., was immediately effective, but temperature, heart rate and carbon dioxide production were all increased for 2 days postoperatively in spite of repeated dantrolene administration.

Dantrolene↗

Transient carpal tunnel syndrome accompanying rubella infection.

Four children are presented with otherwise uncomplicated rubella infection suffering from transient carpal tunnel syndrome. The diagnosis was confirmed by repeated measurements of sensory conduction velocity and sensory action potential amplitude. The symptoms were only nocturnal. They disappeared rapidly but the neurophysiological changes normalized slowly. The possibility of a carpal tunnel syndrome should be considered in a child with rubella complaining of numbing or tingling fingers during the night.

Action Potentials↗

Brain-orientated intensive care treatment in severe neonatal asphyxia. Effects of phenobarbitone protection.

The effect of applying brain-orientated neonatal intensive care for term infants with severe neonatal asphyxia was studied. Such treatment included protective phenobarbitone administration together with assisted ventilation and other measures to counteract postasphyxial cerebral oedema and any abrupt changes in blood pressure and oxygenation. The mortality rate and incidence of long-term sequelae were reduced appreciably, resulting in a 0-1 year mortality rate of 14% (previously 50%) and an incidence of neurodevelopmental handicap at 18 months of 17% (previously 50%). It is important in the management of infants with severe asphyxia at birth to avoid blood pressure fluctuations and to control neuronal epileptic activity by the use of barbiturates and early ventilator treatment.

Asphyxia Neonatorum↗

Cerebral metabolic and circulatory changes in the rat during sustained seizures induced by DL-homocysteine.

Sustained, generalized seizure activity was induced in anaesthetized (70% N2O), paralyzed and artifically ventilated rats by i.p. DL-homocysteine thiolactone in a dose of 11 mmol/kg. Epileptic discharges in the EEG were accompanied by marked perturbation of tissue metabolites. There was a fall in phosphocreatine concentration to 40% of control but only moderate changes in adenine nucleotides, a marked rise in lactate concentration, and a pronounced increase in the lactate/pyruvate ratio. Excessive amounts of dihydroxyacetone phosphate (and glyceraldehyde phosphate) accumulated, indicating that depletion of NAD+ occurred. There was marked accumulation of ammonia, glutamine and alanine, and reduction in glutamate and aspartate concentrations. Administration of a subconvulsive dose of homocysteine (7.5 mmol/kg) gave rise to changes in ammonia and amino acids, qualitatively similar to those occurring during seizures. It is concluded that although changes in the metabolites of the energy reserve were mainly caused by the induced seizures, those affecting amino acid concentrations were significantly influenced by accumulation of ammonia, secondary to metabolism of injected homocysteine. Cerebral blood flow (CBF) and oxygen utilization (CMRO2) were measured during sustained seizures. CMRO2 rose to 150% of control, with a corresponding increase in CBF.

Amino Acids↗

Effects of reduced cerebral blood flow upon EEG pattern, cerebral extracellular potassium, and energy metabolism in the rat cortex during bicuculline-induced seizures.

Progressive cerebral ischemia was induced by blood pressure (BP) reduction in rats during status epilepticus, and the sequence of cerebral functional (EEG, extracellular K+ activity) and metabolic (levels of high energy phosphates, glucose, glucose-6-phosphate, lactate, pyruvate, alpha-ketoglutarate) changes were determined. Very moderate reductions of BP were accompanied by tissue lactate accumulation and a decrease of the rate of re-uptake of K+ extruded during discharges. These changes were pronounced at BP about 50 mm Hg, when also the energy state showed some deterioration, and the EEG activity changed from one of bursts and suppressions into single spikes. At BP about 30 mm Hg EEG activity was abolished, but not until a slightly lower BP level was there a severe energy depletion and a massive K+ release, indicating generalized membrane depolarization. The results show an increased susceptibility to ischemia during seizures with changes of membrane pump function, and energy metabolism appearing at moderate reductions of BP. Concomitant decrease of seizure activity delayed to some extent the development of massive energy failure and membrane depolarization.

Animals↗

Effects of bicuculline-induced seizures on cerebral metabolism and circulation of rats rendered hypoglycemic by starvation.

To evaluate the effects of substrate deficiency on cerebral function, metabolism, and blood flow during seizures, rats were injected intravenously with bicuculline (1.2 mg.kg-1) following a 24-hour period of starvation. During the course of seizures, blood glucose concentrations fell, and when they were reduced to below about 3 mumol.gm-1, cerebral function, metabolism, and blood flow altered. Changes in function involved the transition of an electroencephalographic pattern of bursts and suppression into one of frequent or sparse single spikes. Oxygen consumption, which initially increased at least twofold, fell toward normal or subnormal values in the single-spike period. Cortical blood flow was markedly reduced, and there was an attenuated response to carbon dioxide administration. Simultaneously, a small but clear fall was detected in the cerebral phosphorylation potential, and concentrations of glycolytic metabolites (including lactate) and citric acid cycle intermediates were reduced. Changes in amino acids and ammonia were somewhat similar to those observed in insulin-induced hypoglycemia, but since the amino acid pool did not fall, the experiments failed to give evidence that amino acids serve as oxidative substrates. The perturbation of cerebral energy state (and of levels of carbohydrate substrates and amino acids) was reversed by glucose administration; but since neither this procedure nor additional bicuculline injections could cause resumption of continuous seizure activity, the results suggest that cellular substrate depletion may have given rise to a sustained disturbance of synaptic transmission.

Animals↗

Epileptic brain damage: the role of systemic factors that modify cerebral energy metabolism.

The possible role of systemic physiological changes (occurring secondarily during status epilepticus) in the causation of epileptic brain damage has been evaluated in rats. Animals were anaesthetized, paralysed and mechanically ventilated; sustained electrocortical seizure discharges were induced by the intravenous injection of bicuculline, 1.2 mg/kg. After two hours of seizure activity brains were fixed by perfusion for histology. Physiological variables were maintained within certain limits from the end of the initial seizure phase (approximate duration twenty minutes) until two hours after onset of seizure to provide six groups: (1) Standard: mean arterial pressure above 120 mmHg, no hypoxia or hypoglycaemia, rectal temperature close to 37 degrees C. (2) Moderate Hypotension: mean arterial pressure at 70-75 mmHg. (3) Severe Hypotension: mean arterial pressure at 50 mmHg. (4) Hypoxia: arterial oxygen tension at 50 mmHg. (5) Hypoglycaemia: non-fed animals, with blood glucose close to 3.0 mumol/g. (6) Hyperthermia: rectal temperature at 40 degrees C. Microvacuolation and ischaemic cell change were identified by light microscopy in scattered neurons in the cortex (principally in the outer layers) in animals in three groups (Standard, Severe Hypotension and Hyperthermia). Similar neuronal changes were seen in the hippocampus (predominantly in the h1 or Sommer sector) in the Standard and Hyperthermia Groups. It is tentatively proposed that neuronal damage in animals with unrestricted cerebral oxygen and glucose availability is due to oxidative mechanisms in cells with excessively enhanced neuronal activity and that lesions caused by failing energy production do not appear until severe degrees of hypoxia are reached.

Animals↗

A study on the fate of curcumin in the rat.

The uptake, distribution and excretion of curcumin in Sprague-Dawley rats has been studied. When administered orally in a dose of 1 g/kg, curcumin was excreted in the faeces to about 75%, while negligible amounts of curcumin appeared in the urine. Measurements of blood plasma levels and biliary excretion showed that curcumin was poorly absorbed from the gut. No apparent toxic effects were seen after doses of up to 5 g/kg. When intravenously injected or when added to the perfusate of the isolated liver, curcumin was actively transported into bile, against concentration gradients of several hundred times. The major part of the drug was however metabolized. In suspensions of isolated hepatocytes or liver microsomes 90% of the added curcumin was metabolized within 30 min. In view of the poor absorption, rapid metabolism and excretion of curcumin, it is unlikely that substantial concentrations of curcumin occur in the body after ingestion.

Administration, Oral↗

On cerebral infarction in childhood and adolescence.

This report is based on a retrospective analysis of clinical and angiographic findings in 14 children and adolescents suffering from cerebral infarction. They were all examined during the acute stage and selective angiography was performed within a day or two of the stroke. Pathogenesis is discussed and focuses particularly on the occurrence of segmental arteritis from unknown (infectious?) aetiology.

Adolescent↗

Neonatal and prospective follow-up study of infants delivered by vacuum extraction (VE).

Forty infants delivered by vacuum extraction have been studied in the neonatal period--neurological examination, neonatal CSF-examinations, skull X-ray examination, transillumination and sonoencephalography --and at 14 months of age--developmental and behavioural evaluation, neurological examination, skull X-ray examination, sonoencephalography and electroencephalography. Two infants died in the neonatal period but in both cases a life-threatening situation of the fetus required immediate delivery. CSF cytological signs of haemorrhage were observed in 42% of the 26 infants who had a successful lumbar tap, compared to 10% found in normal deliveries. The result of the neonatal neurological study did not differ from that in a control group. The result of the skull X-ray examination and sonoencephalography were also within normal limits. In the follow-up study behavioural problems were found in 25%, but otherwise very few abnormalities were found. The deviatiosn found do not for the present indicate any later signs of brain lesions. It is concluded that this prospective study has shown that VE-delivery in fullterm babies seem to imply no risk fo serious cerebral sequelae. Further follow-up studies at a later age in order to evaluate the incidence of so-called minimal brain damage in VE-delivered children are required.

Adult↗