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Biomedical subjects

J Eklund

Publications and source records attributed to J Eklund.

At least 19 recordsLinked to original sources
PubMed1992

Serum steroids and prolactin during and after major surgical trauma.

Serum levels of cortisol, dehydroepiandrosterone (DHA) and its sulfate (DHAS), 4-androstene-3,17-dione (A-4), 17-alfa-hydroxy-progesterone (17 OHP), testosterone (T, only in males), unconjugated (E1) and total estrone (tE1 greater than 85% estrone sulfate) were studied in six male and two female patients before, during and up to 30 days after aortic graft surgery. All steroids except 17 OHP decreased following induction of anesthesia but, except for testosterone, rose again during surgery to preoperative levels or slightly above. Extremely high peak values for E1 and tE1 and a less pronounced peak for cortisol were noted on postoperative day 2; after that, the levels of these steroids returned to normal. The levels of 17-OHP, DHA and DHAS decreased after surgery and were below preoperative values from postoperative day 4 to day 16 or (DHAS) day 30. In males, 17 OHP showed a pronounced peak 30 min after initiation of surgery, but decreased after that to below preoperative values. Testosterone levels decreased further during surgery and remained very low until postoperative day 16. Major surgical trauma has a rapid, profound and long-lasting effect on gonadal activity, as judged from decreased testosterone levels, while the effect on adrenal steroids is less pronounced. Adrenal delta 4 and delta 5-steroids showed different patterns in the postoperative period, indicating differences in their regulation. The highly elevated estrogen levels on postoperative day 2 probably reflect either transiently elevated peripheral aromatization or decreased estrogen metabolism rather than increased levels of substrate steroids (A-4). The biological significance of this remains to be elucidated.

17-alpha-Hydroxyprogesterone↗
PubMed1991

[Scandinavian recommendations for transfusion medicine].

A central issue at the 13th Scandinavian Congress on Blood Transfusion Medicine was national self-sufficiency in plasma and plasma products, as outlined in the resolution adopted by the Council of Europe in 1990. Delegates also discussed the serological screening of donors to prevent the transmission of infection, new developments in the production of blood components, leukocyte filtration and serological technology.

Blood Banks↗
PubMed1990

Uteroplacental blood flow measured by placental scintigraphy during epidural anaesthesia for caesarean section.

The uteroplacental blood flow was measured before and during epidural anaesthesia for caesarean section in 11 women. The blood flow was measured with dynamic placental scintigraphy. After an i.v. injection of indium-113m chloride, the gamma radiation over the placenta was recorded with a computer-linked scintillation camera. The uteroplacental blood flow could be calculated from the isotope accumulation curve. The anaesthesia was performed with bupivacaine plain 0.5%, 18-22 ml and a preload of a balanced electrolyte solution 10 ml/kg b.w. was given. The placental blood flow decreased in eight patients and increased in three with a median change of -21%, not being statistically significant. No correlation between maternal blood pressure and placental blood flow was found.

Adult↗
PubMed1990

The effect on uteroplacental blood flow of epidural anaesthesia containing adrenaline for caesarean section.

The effect on uteroplacental blood flow of an epidural anaesthesia containing adrenaline for caesarean section was investigated in ten healthy women using dynamic placental scintigraphy with indium-113m and a computer-linked gamma camera. The epidural anaesthesia was performed with 18-22 ml bupivacaine 5 mg/ml with adrenaline 2.5 micrograms/ml followed by an i.v. balanced electrolyte infusion of 10 ml/kg b.w. A significant median decrease in the total maternal placental blood flow of 34% was found (P less than 0.01). There was also a significant decrease in maternal mean blood pressure of 3 mmHg (0.4 kPa) (P less than 0.05) and a significant negative correlation between the change in maternal blood pressure and the change in uteroplacental blood flow (r = -0.69, P less than 0.05).

Adult↗
PubMed1988

Impressions for prosthodontic restorations reproducing narrow spaces and severe undercuts.

Distortion of an impression material may occur in special clinical situations in which the material's elastic limit is exceeded. Impressions were made of a master model designed to test such situations. Three different hydrocolloids and an addition silicone were used in the experiment. An extended setting time had to be used for one material, to prevent it from tearing. When this extended time was used, this material was the dimensionally most accurate material in the test. All materials were accurate in reproducing normally positioned abutments, while some of the impressions failed to reproduce adjacent abutments with particularly narrow interspaces; narrow passages may therefore require further tooth preparation. In the most severely undercut area differences existed among the materials, and sometimes tears occurred. When the papilla is missing, the undercut area should be blocked out to prevent plastic deformation of the impression material, causing inaccurate restorations.

Agar↗
PubMed1986

Perinatal mortality from Rh(D) hemolytic disease in Finland, 1975-1984.

Analysis of 41 deaths from Rh(D) hemolytic disease (HDN) in Finland in the past 10 years revealed that 17 occurred in mothers immunized before anti-D IgG was available and three in mothers immunized by blood transfusion in earlier years. Nine deaths were related to loopholes in the anti-D program and could presumably have been prevented by ensuring that all eligible Rh-negative women received anti-D IgG after delivery and abortion. Six deaths were due to immunization during a first pregnancy after the 28th week and three to maternal immunization despite anti-D IgG. Immunization from these sources can only be reduced by anti-D IgG injected antenatally as well as postnatally, though the complete eradication of HDN seems to be beyond our grasp. Giving anti-D IgG to Rh-negative women after the birth of a Rh-positive infant or after an abortion has been common practice in Finland, the former since 1969 and the latter since 1971. Although anti-D prophylaxis has been very effective in reducing the incidence of Rh(D) hemolytic disease, new cases continue to occur. Since the prophylaxis fails to prevent perinatal mortality, we decided to discover how the mothers whose infants died from HDN had become immunized in the past 10 years.

Blood Transfusion↗
PubMed1985

Phosphate supplementation in parenteral nutrition.

Pronounced serum phosphate deficiency has been shown to be deleterious when starting parenteral nutrition in severely malnourished patients. The consequences of phosphate deficiency and the need for phosphate supplementation in critically ill patients are not well known. Thirty ICU patients randomized into two groups were studied. The patients received complete parenteral nutrition with and without addition of extra phosphate. The low phosphate group got 7.5 mmol phosphate (from the phospholipids in the fat emulsion) and the high phosphate group got 60-80 mmol phosphate/day. There were no significant differences in serum phosphate or calcium levels between the groups. In the high phosphate group the phosphate balance was positive and calcium balance zero while in the low phosphate group both phosphate and calcium balances were negative. The phosphate content in a standard nutrition programme is not sufficient to create a positive phosphate balance. With the addition of 80 mmol phosphate/day a positive balance was achieved. It is hard to establish guidelines for the administration of phosphate in ICU patients. 20-40 mmol may normally be satisfactory but we have shown that ICU patients may need and can tolerate up to 80 mmol/day.

Adult↗
PubMed1985

Quantitation of immunoglobulin classes and subclasses in anti-Rh (D) antibodies.

The isotype profiles of anti-Rh (D) antibodies were measured from 16 serum samples with a solid-phase radioimmunoassay that employed monoclonal anti-isotype antibodies. These antibodies had been standardized in another solid-phase system with the aid of monoisotypic antibodies (e.g., anti-tetanus toxoid of isotype IgG4), and this permitted calculations of the relative concentrations of different isotypes in each anti-D population. Of the heavy-chain isotypes, only IgG1 and IgG3 were found in anti-Rh (D) antibodies. The share of IgG1 varied from 100% (2 sera) to 0% (1 serum) of detected units, and the mean proportion was 73.8%. The remainder was IgG3 (mean share 26.2%). The proportions of kappa and lambda immunoglobulins varied greatly in individual sera, in three sera only kappa Ig and in one serum only lambda Ig could be detected.

Humans↗
PubMed1985

Intensive plasma exchange as an adjunct to management of severe rhesus disease.

Large-volume plasma exchange was used to reduce the maternal anti-D concentration in a case of severe rhesus disease. The treatment commenced at 19 weeks' gestation and continued until the infant was successfully delivered at 35.2 weeks' gestation. The initial anti-D level of 30 IU/ml was lowered to 10 and was maintained below that level, with few exceptions throughout the program. The volume of plasma exchanged each week varied between 6.8 and 13.4 liters, a total of 154 l. Three IUTs were accomplished, starting from 31 weeks' gestation. The patient's OD values remained far below those recorded in her previous pregnancy which terminated in neonatal death. The replacement fluids consisted of 98 l PPS with FFP added to equilibrate the patient at the end of each procedure, altogether 33 l. At 33 weeks' gestation she developed a transient non-A, non-B hepatitis probably caused by the use of FFP. However, she later made a complete recovery. Large-volume plasma exchanges commenced early in high-risk pregnancy must be individually designed and based on the kinetics of anti-D production. The replacement fluids should preferably consist of pasteurized albumin solutions and intravenous immune globulin.

Adult↗
PubMed1985

Blood coagulation and fibrinolytic factors as well as their inhibitors in trauma.

Tests generally accepted in the diagnosis of DIC were evaluated in 13 patients with multiple trauma. The blood samples were drawn on admission before treatment with blood, blood products or heparin. The tests included platelet count, prothrombin complex (Normotest/Thrombotest), Factor V, Factor VIII:C, fibrinogen, fibrinogen degradation products (FDP), thrombin and Reptilase times as well as the ethanol gelation test (fibrin monomer). Based on the results of the tests, the patients were categorized into DIC, suspected DIC and no DIC groups. It was found that those patients who were referred to the DIC group were also those who later developed the most severe organ dysfunction and who stayed the longest time in the Intensive Care Unit. Thus, the clinical and laboratory findings agreed. The Normotest/Thrombotest ratio, thrombin times and Reptilase times, and presence of fibrin monomers were of limited value for the diagnosis of DIC. To make a correct diagnosis, the results of several of the conventional tests had to be combined. Additional tests were then evaluated. An increase of the fibrinopeptide A (FPA) level and the Factor VIIIR:Ag (vWF:Ag)/Factor VIII:C ratio in all the DIC patients as well as a decrease of the antithrombin (AT) level in some DIC patients indicated thrombin activity and a risk of thromboembolic events. A decrease of plasminogen and alpha 2-antiplasmin indicated activation of the fibrinolytic system. It is concluded that these new tests are useful in the diagnosis and treatment of DIC and similar proteolytic states.

Adolescent↗
PubMed1984

Blood coagulation and fibrinolytic factors and their inhibitors in critically ill patients.

In a search for new variables, for the diagnosis of disseminated intravascular coagulation (DIC) and for guidelines of therapy in such conditions, 22 severely ill patients were studied. The diagnosis of DIC was based on determinations of platelet counts, prothrombin complex (Normotest), antithrombin (AT), fibrinogen degradation products and fibrinogen. Nine patients were diagnosed as having DIC, eight patients were referred to a suspected DIC group and five to a group of no DIC. The laboratory findings were found to agree with the clinical status. In addition several new parameters were investigated: factor XII, prekallikrein, Simplastin A--another prothrombin complex factor method, factor X, plasminogen (PLG), antiplasmin (AP) and kallikrein inhibitors (KI). Platelet counts, prothrombin complex and antithrombin were mostly pathological in DIC-patients. Of the alternative tests prothrombin complex, fibrinopeptide A and the kallikrein inhibitor as well as the two tests for fibrinolysis (PLG and AP) were significantly altered in DIC-patients. The inhibitor capacity (AT, APV and KI) was lower in patients who died than in survivors and decreased still further in those of the non-survivors who had DIC. Thus the inhibitors can be used as predictors of outcome and hopefully for guiding therapy. To establish the diagnosis of DIC we suggest measurement of platelet count, prothrombin complex, plasminogen as well as of the inhibitors.

Adolescent↗
PubMed1984

A historical review of hydrocolloids and an investigation of the dimensional accuracy of the new alginates for crown and bridge impressions when using stock trays.

Reversible hydrocolloids have been used since 1937 and irreversible hydrocolloids since 1947 for the making of impressions for fixed prostheses; the impression techniques were similar to today's. The dimensional accuracy of reproduction of the irreversible hydrocolloids has been proved since 1947. In this paper the dimensional accuracy of three new alginates, Algi -X ( Algiflex Super, Howmedica Alginate), Ardent Alginate, Ultrafine and a combination material, Colloid 80/ Algiace ( Dentloid / Algiace ) were compared to two agar hydrocolloids and an addition silicone, when different stock trays were used as in the dental clinic. In most clinical situations the new alginates used in metal stock trays are as accurate as the "old" impression materials. The combination material is less accurate when many abutment preparations are to be reproduced. Whether perforated or nonperforated metal stock trays are used with the alginates is of no consequence to the accuracy. Alginates used in disposable plastic trays may cause severe inaccuracy. In narrow spaces with severe unblocked undercuts some of the alginates may be inferior to the other impression materials in this study.

Agar↗