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Biomedical subjects

J Hulting

Publications and source records attributed to J Hulting.

At least 19 recordsLinked to original sources
PubMed1992

Brain-oriented intensive care after resuscitation from cardiac arrest.

The 'chain-of-survival' concept has gained general acceptance in the care of cardiac arrest victims. Most standards and guidelines for cardiopulmonary resuscitation, however, focus on the initial links in the chain. We consider appropriate in-hospital care for the survivors a logical extension of the chain of survival. In recent years extensive research activity has probed the pathophysiology and pharmacology of postischemic reperfusion. The present review discusses the current understanding of mechanisms for cerebral damage following global ischemia. Promising pharmacological principles for protection or resuscitation from cerebral ischemia are reviewed. None of them are considered ready for clinical application. Clinical guidelines are proposed, based on the reviewed data and previously published clinical observations. Cornerstones of the proposed brain-oriented intensive care protocol are: (1) hemodynamic monitoring and meticulous treatment of circulatory disturbances, (2) controlled ventilation providing normoventilation and normoxia to all comatose patients, (3) avoiding hyperglycemia and hyperthermia in comatose patients, (4) adequate analgesia and sedation, tempered by the understanding that oversedation impedes neurological evaluation without promoting recovery. An accurate prognosis can usually be made 48-72 h after resuscitation. This permits reevaluation and assignment to an appropriate level of continued hospital care.

Brain Ischemia↗
PubMed1992

[Acute alcoholic intoxication--risk of complications].

Alcohol intoxication is the commonest cause of unconsciousness among patients admitted to hospital. Studies have shown that, of all acute admissions to medical wards, approximately 20 per cent are patients who are intoxicated or have alcohol-related damage. A study cited in the article showed patients in deep stupor generally to have a blood alcohol concentration above 70 mmol/l, and to be at increased risk of respiratory complications and aspiration of regurgitated stomach content. In cases of severe alcohol intoxication, treatment includes the following: freeing of the airways, perhaps combined with respiratory support; tracheobronchial lavage and aspiration, followed by antibiotic treatment; liberal parenteral thiamine administration; cramp, hypoglycaemia and muscle damage may require special measures; in the acute stage, cardiac arrhythmia usually normalizes without special antiarrhythmic treatment.

Alcohol Withdrawal Delirium↗
PubMed1990

Plasma neuropeptide Y on admission to a coronary care unit: raised levels in patients with left heart failure.

STUDY OBJECTIVE - The aim of the study was to measure plasma neuropeptide Y, which is related to sympathetic nerve stimulation, in patients admitted to a coronary care unit and to relate the findings to clinical information. DESIGN - Plasma neuropeptide Y was measured on admission and the results were related to the cause of admission and to clinical information collected prospectively and retrospectively. SUBJECTS - Plasma subjects were obtained from 377 consecutive daytime admissions to the coronary care unit at Södersjukhuset. Results of only the first sample in each patient are included in this study, so 45 cases observed more than once (readmitted patients) were omitted. Six samples were abandoned because of technical failures. The study therefore comprises 326 patients. Clinical diagnoses were defined as acute myocardial infarction, arrhythmia, angina pectoris, and miscellaneous (all other diagnoses). Heart failure was defined according to a modified Killip scheme. MEASUREMENTS and RESULTS - Neuropeptide Y like immunoreactivity was measured by radio-immunoassay. Plasma concentrations above normal (greater than 30 pmol.litre-1) were found in association with: increased age, female sex, diuretic treatment, tachycardia, arterial hypotension, increased respiratory rate, and mortality in the unit. There was a strong relationship between high neuropeptide Y concentrations and: moderate left heart failure (63%), pulmonary oedema (90%), and cardiogenic shock (100%). Of patients without heart failure only 25% had raised neuropeptide Y. In multivariate analysis, the severity of heart failure (Killip class), heart rate and respiratory rate were the only variables that were significantly and independently related to plasma neuropeptide Y. CONCLUSIONS - The presence and degree of circulatory disturbance, in particular tachycardia and left heart failure, were strongly related to increased plasma concentrations of neuropeptide Y in coronary care patients.

Aged↗
PubMed1990

Elevation of plasma neuropeptide Y-like immunoreactivity and noradrenaline during myocardial ischaemia in man.

Plasma levels of neuropeptide Y-like immunoreactivity (NPY-LI) and noradrenaline were studied for 25 h in 22 patients with acute ischaemic heart disease. On admission, NPY-LI levels were above normal in 16 patients, and 20 patients had increased noradrenaline levels. The initial plasma NPY-LI did not differ between patients with acute myocardial infarction (AMI) and angina pectoris. Initial plasma noradrenaline levels were higher in patients with AMI than in those with angina pectoris. Plasma levels of noradrenaline remained elevated in AMI patients, but decreased towards normal values in patients with angina pectoris. Levels of NPY-LI returned to normal within 25 h in all patients. Tachycardia and left ventricular failure were related to high NPY-LI and noradrenaline levels. A positive correlation was found between noradrenaline and NPY-LI in plasma. It is suggested that neuropeptide Y (NPY), an endogenous vasoconstrictor peptide, should be considered as one of the mediators involved in the cardiovascular response to sympathetic activation induced by myocardial ischaemia.

Aged↗
PubMed1989

Computer-detected ventricular tachycardia in the coronary care unit: prognosis in patients with and without acute myocardial infarction.

Survival (for up to 6 years) in coronary care unit (CCU) patients with ventricular tachycardia (VT) was studied with the aid of an automated arrhythmia monitoring system. Ventricular tachycardia was defined as four or more consecutive ventricular beats with a rate above 120 per min. During an 18-month period. VT was observed in 102 individuals (13%) out of 800 patients without acute myocardial infarction (AMI). The 102 patients were compared with age- and sex-matched patients with AMI and VT and a group with AMI but without VT. Hospital mortality was 27% in patients with AMI and VT, 23% in patients with AMI without VT, and 16% in non-AMI patients with VT (NS). First year mortality after discharge was 20% in the non-AMI group compared to 12% in the AMI groups (NS). The 1-6 years survival curves also did not differ significantly between the groups with a yearly mortality of between 5 and 6%. Acute myocardial infarction patients with rapid VT (greater than 150 min-1) or long VT (more than 10 beats) had a higher hospital mortality, otherwise the number or type of VT episodes did not relate to short- or long-term prognosis in the studied groups. Ventricular tachycardia in the CCU did not seem to be an indicator of poor long-term prognosis. It is concluded that long-term prognosis in patients with VT in the CCU was little influenced by a current diagnosis of AMI.

Aged↗
PubMed1988

Decreased red cell filterability in patients with acute myocardial infarction.

The red cell filterability was decreased in patients with acute myocardial infarction (AMI) when compared with healthy controls, 14.6 (12.2-16.3) units and 16.9 (15.6-17.4) units respectively, P50 (P25-P75), p less than 0.001). No significant correlations could be seen within the AMI group between the decrease in filterability and the levels of serum aspartate aminotransferase or serum lactate dehydrogenase. The erythrocyte filterability, however, correlated to the serum concentrations of hepatic enzymes in AMI. The addition of sodium lactate in vitro in physiological concentrations (0.9-3.6 mM/l final concentration) lowered the erythrocyte filterability markedly to 2.7 (0-9.8) units in a dose-dependent manner, supporting the hypothesis that the decrease in erythrocyte filterability in AMI might be caused by an increase in the lactate concentration.

Aged↗
PubMed1985

Unusual neurological symptoms in a case of severe crotalid envenomation.

In Sweden bites by non-European venomous snakes are reported to the Poison Information Centre 5-10 times annually. These incidents generally take place in private homes and may result in severe poisoning. We report a recent case of envenomation from a bite by Crotalus durissus terrificus with a prolonged, atypical course. The patient, a 24-year old man, was admitted to hospital approximately eight hours after the snakebite. On admission we noted coma, circulatory failure, hypofibrinogenaemia with bleeding from fang marks on his right arm, melaena and haematemesis. Antishock therapy including intravenous fluids, steroids and epinephrine was instituted immediately and within six hours infusion of polyvalent antivenom was started. Next day, when the initial disturbances were corrected, peripheral neurological features were noted and the patient gradually became comatose. Antivenin therapy was reinstituted. The coma lasted for one week and recovery extended over several months with persisting neurological symptoms. Six months after the bite there were still pathological findings in the electromyogram.

Adult↗
PubMed1983

Massive metoprolol poisoning treated with prenalterol.

A case of massive metoprolol poisoning (50 g) is described. Clinical signs included coma, seizures, hypoventilation, unmeasurable blood pressure, nodal bradycardia, and metabolic acidosis. Treatment comprised intubation, assisted ventilation, gastric lavage, atropine, bicarbonate, glucagon and repeated doses of prenalterol (a total of 160 mg over 15 hours). Prenalterol dosage was simple and could be guided by blood pressure response. Pacemaker treatment was not required. Ethanol concentration was 50 mmol/l (2.4%) on admission. Plasma metoprolol was 68 mumol/l (18 000 ng/ml) 2 hours after admission. The patient was awake after 15 hours.

Adult↗
PubMed1979

Kinetics of hemodynamic and electrocardiographic changes following intravenous disopyramide.

Changes in hemodynamic and ECG variables following disopyramide (1.7 mg = 3.9 mmol/kg b.wt.) were studied in 9 patients with ventricular arrhythmias. All patients displayed a marked reduction in the number of ventricular ectopic beats, all except one exhibiting complete abolition of the arrhythmia for at least 30 min. QT and QRS intervals showed statistically significant prolongations, and thereafter decreased exponentially with time. Above a certain concentration threshold that varied between the patients, systolic time intervals and aortic (dp/dt)max showed linear changes with increasing drug serum levels. Changes in diastolic pulmonary artery pressure showed no simple relationship with disopyramide concentration or time after injection. In 3 out of 4 patients studied, there was a good correlation between the lowest level of disopyramide that elicited both an antiarrhythmic effect and a demonstrable decrease in cardiac contractility.

Adult↗