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Biomedical subjects

J Modig

Publications and source records attributed to J Modig.

At least 73 records · Page 4Linked to original sources
PubMed1984

Complement activation and its relationship to adult respiratory distress syndrome. An experimental study in pigs.

Pulmonary leucostasis induced by complement activation has been considered an important pathogenic factor in adult respiratory distress syndrome (ARDS). To determine whether complement activation per se could evoke pulmonary dysfunction similar to ARDS, pigs were repeatedly infused with complement-activated plasma (CAP). Complement activation was produced by incubation of plasma with zymosan. Three groups of animals were investigated. Control animals received non-activated plasma. Nine animals (Group II) were given four infusions of CAP at a rate of 7 ml X min-1, and another nine animals (Group III) received two CAP infusions at a rate of 7 ml X min-1 followed by two at a rate of 14 ml X min-1. In the control animals there were no changes in gas exchange or haemodynamic variables and the leucocyte counts gradually increased. Infusion of CAP resulted in transient peripheral leucopenia and a dose-rate-dependent reversible increase in pulmonary vascular resistance in all animals. In one animal of Group II and in six of Group III there was a significant infusion-related decrease in Pao2 due to increased venous admixture. These animals were characterized by an enhanced pulmonary vascular tone before the start of the first CAP infusion. They also displayed a more pronounced pulmonary vascular response to infusion of CAP. The changes in gas exchange variables and pulmonary haemodynamics showed no relation to the degree of leucopenia or decrease in platelet count. The increased venous admixture was caused by "dry" ventilation/perfusion mismatching and not by oedema. These results suggest that additional factors besides complement activation and pulmonary leucostasis are required for the development of increased microvascular permeability and the pulmonary oedema characterizing ARDS.

Animals↗
PubMed1984

Value of chest radiography in adult respiratory distress syndrome.

In a prospective investigation of 19 patients with traumatic (n = 11) and septic (n = 8) shock at risk of developing the adult respiratory distress syndrome (ARDS), serial chest films were monitored. Eight patients developed ARDS, 2 following traumatic shock and 6 following septic shock. Only 2 of these 8 patients exhibited radiographic abnormalities consisting in bilateral widespread infiltrates of the alveolar type. In the 2 patients ARDS had already developed before artificial ventilation with positive end expiratory pressure (PEEP) was instituted. In the other 6 patients, in whom ventilator treatment with PEEP was initiated prophylactically or early in the disease, the chest films remained virtually normal despite development of a marked pulmonary insufficiency. It is concluded that early ventilator treatment with PEEP counteracts the classical radiographic abnormalities of ARDS, probably by reducing alveolar oedema and atelectasis. Thus, presently, with use of early or prophylactic ventilator treatment with PEEP as a therapeutic measure against ARDS chest radiography may be of limited value in the diagnosis. However, it should be essential for early recognition of therapy requiring complications.

Adolescent↗
PubMed1983

Advantages of dextran 70 over Ringer acetate solution in shock treatment and in prevention of adult respiratory distress syndrome. A randomized study in man after traumatic-haemorrhagic shock.

Twenty-three patients aged 20-58 years in a serious state of shock and suffering from major pelvic and femoral fractures sustained in traffic accidents were studied. As initial fluid management, either dextran 70 (1000-1500 ml) together with Ringer's acetate solution (2000-3000 ml), or Ringer's acetate alone (5000-8000 ml), was administered on a random basis. Thus, 12 patients received dextran and 11 patients crystalloid treatment to counteract shock. Both groups were given whole blood. The resuscitation time--i.e. the interval from the start of fluid therapy until a stable circulatory condition was achieved--was significantly shorter (P less than 0.001) in the dextran group (108 +/- 18 min; mean +/- S.D.) than in the Ringer group (170 +/- 43 min). During the post-resuscitative observation period of 6 days the dextran patients were given 500 ml of dextran daily, while the Ringer group did not receive any colloidal solution. To maintain a stable circulation and a urinary output above 50 ml/h the Ringer patients required significantly more (P less than 0.001) crystalloid solution (910 +/- 300 ml) daily than the dextran patients (460 +/- 400 ml). The frequency of adult respiratory distress syndrome (ARDS) was significantly lower (P less than 0.05) in the dextran group (0 of 12) than in the Ringer group (4 of 11). Thus, in the initial treatment of traumatic-haemorrhagic shock and in the post-resuscitative period dextran 70 would seem of advantage over Ringer's acetate both in shortening the shock period and in reducing the frequency of adult respiratory distress syndrome.

Adult↗
PubMed1983

Role of extradural and of general anaesthesia in fibrinolysis and coagulation after total hip replacement.

Thirty patients undergoing total hip replacement were randomly allocated to one of two groups. One group (n = 14) received extradural anaesthesia with 0.5% bupivacaine with adrenaline continued into the postoperative period (24 h) for pain relief. The other group (n = 16) received general anaesthesia with controlled ventilation, using nitrous oxide in oxygen and fentanyl i.v. Following surgery they received a narcotic analgesic i.m. on demand. Analysis of fibrinolysis inhibition activity and plasminogen activators revealed a significantly better fibrinolytic function in patients given continuous extradural anaesthesia than in those who received general anaesthesia followed by narcotics in the period after operation. Furthermore, the capacity for activation of factor VIII was significantly lower after operation in the former group.

Aged↗
PubMed1983

The value of variables of disseminated intravascular coagulation in the diagnosis of adult respiratory distress syndrome.

UNLABELLED: In an investigation on 19 patients with traumatic (n = 11) and septic (n = 8) shock, at risk of developing adult respiratory distress syndrome (ARDS), various coagulation and fibrinolysis variables and also blood gases and chest x-ray were monitored. Eight patients developed ARDS - two after traumatic shock and six following septic shock. LABORATORY FINDINGS: the conventional disseminated intravascular coagulation variables (fibrinogen, platelet counts, activated partial thromboplastin time, ethanol gelation test, thrombotest, normotest and fibrin degradation products) could not discriminate between ARDS and non-ARDS patients, but showed an essentially similar reaction pattern in these two groups. Antithrombin-III and plasminogen levels were significantly lower in patients with ARDS, while factor VIII-related antigen levels were significantly higher in ARDS than in non-ARDS patients. CLINICAL DATA: patients with septic shock run a significantly greater risk of developing ARDS (6 of 8) than those with traumatic shock (2 of 11; P less than 0.02). Furthermore, the onset of ARDS after septic shock seems to occur in a more rapid way, while ARDS following traumatic shock develops more gradually. Early ventilator treatment with positive end expiratory pressure counteracts the classical radiographic picture of ARDS with bilateral alveolar densities.

Adolescent↗
PubMed1983

Fibrinolysis inhibition and fibronectin in the blood in patients with the delayed microembolism syndrome.

Various parameters of fibrinolysis inhibition and the plasma concentration of fibronectin (alpha 2-surface binding glycoprotein, cold insoluble globulin) were measured in patients at risk of developing acute progressive respiratory sufficiency following trauma or sepsis - the delayed microembolism syndrome (DMS). Most parameters measuring fibrinolysis inhibition were significantly higher in the five patients with DMS than in five patients who did not develop the syndrome. Thus, the primary fibrinolysis inhibitor (alpha 2-antiplasmin) was enhanced and the alpha-form of this inhibitor, with affinity to plasminogen, showed the greatest increment and might be of major importance for the delayed elimination of fibrin from the lungs occurring in these patients. The fibronectin concentrations were not lower in patients with DMS than in those who did not develop the syndrome.

Adult↗
PubMed1983

Thromboembolism after total hip replacement: role of epidural and general anesthesia.

The effects of continuous epidural anesthesia and of general anesthesia on the incidence of thromboembolism following total hip replacement were studied. Sixty patients were randomly allotted to one of two groups receiving either epidural or general anesthesia. Epidural anesthesia (N = 30) consisted of 0.5% bupivacaine with epinephrine intraoperatively; for pain relief in the postoperative period (24 h), 0.25% bupivacaine with epinephrine was given every 3 h. General anesthesia (N = 30) consisted of controlled ventilation with N2O-O2 and intravenous fentanyl and pancuronium bromide; postoperatively, narcotic analgesics were given intramuscularly on demand for pain relief. Significantly lower frequencies were found following epidural anesthesia than after general anesthesia in deep venous thrombosis involving the popliteal and femoral veins (13% and 67%, respectively), deep venous thrombosis involving both calf and thigh veins (40% and 77%), and pulmonary embolism (10% and 33%). Possible explanations for these differences include increased circulation in the lower extremities, less tendency for intravascular clotting to occur, and more efficient fibrinolysis in association with continuous epidural anesthesia. The decrease in blood loss associated with epidural anesthesia with lower transfusion requirements also might play a role. Epidural analgesia prolonged into the postoperative period, in addition to other appropriate thromboprophylactic measures, should be of value in patients undergoing operations associated with a high risk of thromboembolic complications.

Aged↗
PubMed1982

Fibrinolysis inhibition after a major standardized trauma.

The present investigation on 20 patients after total hip replacement surgery has confirmed that the posttraumatic increase of the fibrinolysis inhibition activity (FIA) in serum and plasminogen-depleted serum is due to the primary fibrinolysis inhibitor (PFI, alpha 2-antiplasmin). This protein exists in at least two forms and it was indicated that PFI alpha with affinity to immobilized plasminogen, is mainly responsible for the posttraumatic variations of the FIA in plasminogen-depleted serum. PFI beta, the major part of the PFI-related antigen, which has none or low such affinity, displayed weak FIA and relatively small increase after the surgical trauma. It was established that the posttraumatic increase of the FIA was not derived from the low molecular weight fraction in serum of those patients.

Aged↗
PubMed1981

A comparison of epidural morphine and epidural bupivacaine for postoperative pain relief.

In 32 patients subjected to total hip replacement, postoperative pain relief was achieved by random treatment with either 5 mg of morphine in 10 ml of saline (n = 15) or 6-8 ml of 0.5% bupivacaine with epinephrine (n = 17), both drugs administered by the lumbar epidural route. In an additional group of 10 patients, post-traumatic thoracic or post-operative abdominal pain was relieved first by 4-6 ml of 0.5% bupivacaine with epinephrine and subsequently by 5 mg of morphine in 10 ml of saline, both drugs being administered by the thoracic epidural route. The duration of analgesia was significantly longer, on average, with morphine (28 h) than with bupivacaine (4.3 h) when the drugs were given by the lumbar route. Thoracic administration of morphine also resulted in a significantly longer duration of pain relief (on average 9.8 h) than that of bupivacaine (3.8 h). Morphine gave satisfactory pain relief in all cases. It was not associated with motor block, loss of sensitivity to temperature, touch, or pin-prick, or any signs of sympathetic block, as was the case with epidural bupivacaine. Plasma concentrations of morphine were not detectable 8 h after injection, though the patients still had pain relief. One case of delayed severe respiratory depression occurred 6 h after morphine injection via the thoracic route. Epidural morphine analgesia should therefore be reserved for patients in whom continual surveillance is possible, at least until more is known about the pharmacokinetics of narcotics in the epidural and subarachnoid space.

Aged↗
PubMed1981

Effects of tocainide, an oral analogue of lidocaine, on thromboembolism after total hip replacement.

In an investigation of deep venous thrombosis and pulmonary embolism, where neither dextran nor other antithrombotic drug prophylaxis was employed, 30 patients subjected to total hip replacement under general anaesthesia were randomly allotted to one of two groups. One group (n=15) received tocainide, an oral analogue of lidocaine, as a means of preventing thromboembolism; the other group (n=15) served as a control. In patients given tocainide the frequency of deep venous thrombosis involving the femoral veins, as observed at phlebography, was 60% (9 of 15), and in the control group 73% (11 of 15). The frequency of pulmonary embolism, as determined by pulmonary perfusion lung scanning, was 20% (3 of 15) in the the tocainide group and 33% (5 of 15) in the control group. It was concluded that tocainide administration had no effect as an antithromboembolic agent. Phlebography revealed that the pattern of deep venous thrombosis after total hip replacement was characterized by a high frequency of isolated thigh vein thrombi in the operated leg, probably related to the surgical procedure. A finding of possible clinical significance was that patients given tocainide had a significantly lower intraoperative blood loss than control patients.

Aged↗
PubMed1981

Comparative influences of epidural and general anaesthesia on deep venous thrombosis and pulmonary embolism after total hip replacement.

In an investigation on deep venous thrombosis and pulmonary embolism, where neither dextran nor antithrombotic drug prophylaxis were employed, 30 patients undergoing total hip replacement were randomly allotted to one of two groups receiving either epidural or general anaesthesia. The epidural group (n = 15) was given 0.5% bupivacaine with epinephrine (5 micrograms/ml) and this was prolonged into the postoperative period for pain relief. The general anaesthesia group (n = 15) was operated on under artificial ventilation with nitrous oxide/oxygen via an endotracheal tube and intravenously administered fentanyl and pancuronium bromide. In this group of patients narcotic analgesics (ketobemidone) were given intramuscularly on demand for pain relief postoperatively. The frequency of deep venous thrombosis involving the femoral veins, as observed at phlebography, was significantly lower in patients receiving continuous epidural block (3 of 15; 20%), than in those receiving general anaesthesia and parenteral analgesics postoperatively (11 of 15; 73%). Further, the frequency of pulmonary embolism, as determined by pulmonary perfusion lung scanning, was lower in patients receiving continuous epidural block (2 of 15) than in the general anaesthesia group (7 of 15). Possible explanations for these findings are discussed, including a hyperkinetic lower limb blood flow and lower fibrinolysis inhibition activity in patients given epidural block. Lower blood transfusion requirements in patients given epidural block might also play a role, as well as a "stabilizing" effect of local anaesthetics on platelets, leukocytes and endothelial cells.

Anesthesia, Epidural↗
PubMed1980

Effect of epidural versus general anaesthesia on calf blood flow.

The arterial inflow into the calf, venous emptying rate and venous capacity were studied by means of venous occlusion plethysmography on the non-operated leg in two groups of patients undergoing total hip replacement. One group of eight patients received epidural blockade intraoperatively, which was prolonged postoperatively for pain relief, while the other group of eight patients was given general anaesthesia with intermittent positive-pressure ventilation intraoperatively and parenteral analgesics for pain relief in the postoperative period. The calf blood flow and venous capacity were lower in patients receiving general anaesthesia when measured at the end of surgery and significantly lower in this group when measured 3 h postoperatively. The sustained reduction of flow in the deep veins of the lower limb might be a significant contributory factor in the initiation of deep venous thrombosis. In three of the eight patients in the general anaesthesia group, the venous emptying rate and venous capacity had decreased 3 h postoperatively to a very low level, indicating thrombus formation in immediate association with the surgery.

Aged↗
PubMed1980

Effect of dextran on fibrinolysis inhibition activity in the blood after major surgery.

Patients undergoing total hip replacement surgery were given 500 ml of 6% dextran 70 or 5% albumin by intravenous infusion on the third postoperative day when the post-traumatic fibrinolysis inhibition has reached its maximum. The large increase in the fibrinolysis inhibition activity measured by a clot-lysis system was counteracted by the infusion of dextran, whereas the albumin infusion had no such effect. The plasma concentration of antiplasmin (chromogenic substrate assay) and the immunologically determined plasma levels of the primary fibrinolysis inhibitor (alpha2-antiplasmin), alpha2-macroglobulin, alpha2-antitrypsin and plasminogen were not changed after the infusion of dextran. It is hypothesized that dextran exerts its effects partly by interfering with the interaction between the primary fibrinolysis inhibitor, fibrin and plasmin(ogen) and by enhancing the activation rate of plasminogen. This observed effect of dextran may be of importance in the prevention of deep venous thrombosis and pulmonary embolic complications, as well as pulmonary microembolism.

Aged↗
PubMed1980

Posttraumatic pulmonary insufficiency caused by the microembolism syndrome.

On the basis of a series of clinical investigations, our present viewpoints on posttraumatic pulmonary insufficiency due to the microembolism syndrome may be summarized as follows. Two forms of this syndrome exist: 1. An early microembolism syndrome caused by transient deposition of fibrin-rich microemboli in the pulmonary microcirculation, giving rise to a temporarily low ventilation/perfusion ratio. This pulmonary reaction pattern is often subclinical. 2. A delayed microembolism syndrome caused by persistent fibrin-rich microemboli due to fibrinolysis inhibition, giving rise to increased vascular permeability and progressive interstitial and alveolar oedema. This pulmonary reaction pattern leads to pulmonary insufficiency with the characteristic radiographic changes and clinical symptoms of respiratory distress. Whether the early syndrome will develop into the delayed form may depend mainly upon the severity of the trauma, the capacity of the fibrinolytic system to clear the lungs, the form of treatment given, and the cardiopulmonary state of the patients.

Fibrinolysis↗
PubMed1979

Effect of infusion of dextran 70 on fibrinolysis inhibition activity in human serum.

The effect of dextran on fibrinolysis inhibition activity was studied in the serum of normal (uninjured) persons and of post-traumatic patients. An intravenous infusion of 500 ml dextran 70 significantly decreased the fibrinolysis inhibition activity in the serum in both groups. The decrease was greater in the trauma group. Treatment with dextran in the post-traumatic phase may therefore diminish the risk of development of complication due to thromboembolism.

Adolescent↗
PubMed1978

Systemic reactions to tourniquet ischaemia.

In 15 patients, mean age 60 years, undergoing knee arthroplasty under lumbar epidural analgesia, changes in ECG, blood pressure, blood gases, serum potassium, acid-base status and serum creatine-phosphokinase were studied following release of a tourniquet applied for 70-135 min. During and after the ischaemia, the skin temperature of the leg operated on was monitored. Although dextran-70 was rapidly infused following tourniquet release, the blood pressure decreased significantly, due to a reduction in peripheral resistance. There were no signs of myocardial or pulmonary disturbances. Serum potassium in arterial blood increased significantly and reached a peak 3 min after tourniquet release. There was a tendency to metabolic acidosis, most pronounced after 3 min and caused by local lactate production. The skin temperature of the ischaemic leg fell progressively, which, combined with muscular relaxation, indicates a low metabolic rate. There was no evidence of local ischaemic muscular injury. It is concluded that the systemic changes after interruption of up to 2 h of tourniquet ischaemia are moderate and reversible, even in the elderly.

Acid-Base Equilibrium↗
PubMed1977

Posttraumatic pulmonary microembolism. Pathophysiology and treatment.

The aetiology of respiratory insufficiency in man following massive trauma, major surgery or serious illness may vary. There is, however, one special type, the pathogenesis of which remains controversial despite several clinical, autopsy and experimental investigations. Our concept of this syndrome, which is summarized in this review has been arrived at from clinical, pathologico-anatomical and experimental studies. In its pure form the syndrome is most appropriately called "posttraumatic pulmonary microembolism", because the major underlying mechanism is probably a release of thromboplastic products from injured tissues, which generate platelet and fibrin microemboli which are trapped in the lungs during a phase of fibrinolysis inhibition. Preventive measures against pulmonary microembolism include immediate restoration of the haemodynamic state to ensure good tissue perfusion, and prompt reduction and immobilization of internal fixation of long bone fractures. The cardinal feature in the treatment of impending respiratory dysfunction is early institution of volume-controlled ventilation, using positive end-expiratory pressures of between 8 and 15 cm H2O synchronously with low dose heparin treatment and administration of one or two high doses of corticosteroids.

Adrenal Cortex Hormones↗