PubMed Health⌕ Search

Biomedical subjects

L E Linder

Publications and source records attributed to L E Linder.

At least 37 records · Page 2Linked to original sources
PubMed1991

Long-term, open catheterization of the spinal subarachnoid space for continuous infusion of narcotic and bupivacaine in patients with "refractory" cancer pain. A technique of catheterization and its problems and complications.

The technique of long-term, open catheterization of the spinal subarachnoid space for infusion of analgesics in patients with refractory cancer pain is sparsely reported in the literature. We report on a technique using 18G Portex nylon catheters and 16G-17G Tuohy needles, and its problems and complications. One hundred fifty-seven catheters were inserted in 142 patients, in most of them (79%) under deep sedation and local anesthesia. Attempts were made to place the catheter tip as close to the painful segments as possible. The catheters were tunneled subcutaneously (87% of them paravertebrally, over the shoulder, and further parasternally to the third chondrocostal cartilage). The Luer connections of the catheters were fixed to the patients' skin with monofilament steel sutures of dimension 0 and connected to a bacterial filter. At the end of the procedure, 10 ml isotonic saline was injected intrathecally to prevent postspinal puncture headache. Absorbent and impermeable dressings were applied over the tunnel exit, catheter Luer connection and bacterial filter. Antibiotics were given on the day of insertion and 2 days thereafter. During the insertion procedure, the following problems and complications were encountered; two or more attempts before successful spinal-dural puncture (32%), accidental puncture of an extradural vessel (10%), difficult dural puncture (18%), absence of free dripping of cerebrospinal fluid (CSF) in spite of successful dural puncture (4%), blood-stained CSF (9%), radicular pain and paresthesiae (4%), difficult advancement of the catheter (6%), difficult tunneling (11%), and bleeding in the tunnel (0.7%).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

Long-term intrathecal morphine and bupivacaine in "refractory" cancer pain. I. Results from the first series of 52 patients.

Neither epidural (EDA) or intrathecal (IT) morphine nor EDA opiate + bupivacaine provides acceptable relief of some types of cancer pain, e.g. pain originating from mucocutaneous ulcers, deafferentation pain, continuous and intermittent visceral and ischaemic pain, and that occurring with body movement as a result of a fracture. To improve pain relief in such conditions, we gave combinations of morphine and bupivacaine through open IT-catheters to 52 patients with "refractory", severe (VAS 7-10 out of 10), complex cancer pain (Edmonton Stage-3), for periods of 1-305 (median = 23) days. The efficacy of the treatment was estimated from: 1) daily dosage (intraspinal and total opiates, and intraspinal bupivacaine), and 2) scores of non-opiate analgesic and sedative consumption, gait and daily activities, and amount and pattern of sleep. Forty-four patients obtained continuous and acceptable pain relief (VAS 0-2), 26 of them with daily doses of IT-bupivacaine of less than or equal to 30 mg/day (less than or equal to 1.5 mg/h). Higher IT-bupivacaine doses (greater than 60-305 mg/day), not always giving acceptable pain relief, were necessary in 13 patients with deafferentation pain from the spinal cord or brachial or lumbosacral plexuses or pain from the coeliac plexus, or from large, ulcerated mucocutaneous tumours. By combining IT-bupivacaine with IT-morphine, it was possible to use relatively low IT-morphine doses (10-25 mg/day during the first 2 months of treatment) in more than half of the patients. The IT-treatment significantly decreased the total (all routes) opiate consumption and significantly improved sleep, gait and daily activities. For the whole period of observation (6 months), the IT-treatment was assessed as adequate in 3.8%, good in 23.1%, very good in 59.6% and excellent in 13.5% of the cases. Adverse effects of the IT-bupivacaine (paraesthesiae, paresis, gait impairment, urinary retention, anal sphincter disturbances and orthostatic hypotension) did not occur with doses of 2.5-3.0 mg/h (approx. 60-70 mg/day).

Adult↗
PubMed1991

Treatment of neck and shoulder pain in whip-lash syndrome patients with intracutaneous sterile water injections.

Ten whip-lash syndrome patients treated with intracutaneous triggerpoint injections with sterile water for pain relief were followed for 2 months. Pain intensity was evaluated with the Visual Analogue Scale (VAS). Eight patients became free from pain (VAS 0) and two patients improved to VAS 2 immediately after the treatment. Nine patients remained free from pain, three of them after one treatment, while six patients needed 2-4 treatments. One patient responded only a few hours after each of three treatments. Remarkably, with the relief of pain mobility was normalised in all patients. The method is suggested to be a first choice in the treatment of not only whip-lash patients but also for most acute and chronic musculo-skeletal triggerpoint pain syndromes.

Adult↗
PubMed1991

Penetration forces in cannulation of the dorsal veins of the hand: I. A comparison between polyurethane (Insyte) and polytetrafluoroethylene (Venflon) cannulae. Results of a study in volunteers compared with those from an in vitro study.

UNLABELLED: The functional tip tapering design of peripheral venous cannulae (introducer steel needle + catheter) made of polyurethane (PUR-Instye) and polytetrafluoroethylene (PTFE-Venflon) was studied with 3 techniques: A) Scanning electron microscopy (SEM). B) Measurement of penetration forces in vitro through latex membranes and lamb skins with a tensile-compression apparatus (Instron-1122) at 1) the introducer steel-needle point, 2) the needle heel (the spot marking the passage from the point of the needle to its shaft). 3) the catheter top (i.e. the beginning of the plastic sheath), 4) the catheter tip, i.e. the beginning of the largest diameter of the plastic sheath, and 5) between the catheter tip and its hub (catheter friction). C) Two cannulae (one of each type for every subject were inserted at random into the dorsal veins of the left and right hand in 37 volunteers, and the penetration forces were measured with a force transducer. RESULTS: A) The PUR-cannulae had a lancet-like appearance and a smoother transition at the catheter top, whilst the PTFE cannulae were arrow-like, cut back and had a less accentuated conical design. B) Penetration forces in vitro through latex membranes were 9-41 times lower (P less than 0.0001) than those through the large skins. The highest forces (mean +/- s.d.) registered in vitro (lamb skins) were 4.1 +/- 0.2 Newtons (N) with PUR-cannulae at the catheter tip, and 3.4 +/- 0.6 with the PTFE-cannulae at the catheter top (P less than 0.05). C).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Epidural versus intrathecal morphine-bupivacaine: assessment of consecutive treatments in advanced cancer pain.

Twenty-five patients with multifocal and multitype (somatic, visceral, and neurogenic) advanced cancer pain who experienced severe pain despite extradural (ED) morphine and bupivacaine were converted to intrathecal (IT) morphine and bupivacaine. The consecutive ED and IT periods (2-174 days, median = 50 days, and 1-305 days, median = 37 days, respectively) were assessed in clinical terms (daily analgesic dosages giving acceptable pain relief and quality of life expressed as sleeping hours and walking/daily activities). With the IT treatment, the total (all routes) opiate consumption and the daily doses of spinal morphine and spinal bupivacaine decreased significantly at the beginning of the treatment compared to the ED period, and continued to be significantly reduced for up to 1 wk for spinal opiate and bupivacaine and 6 mo for total opiate. The spinal opiate and bupivacaine doses were still lower in 50% of the patients at the end of the IT treatment compared to the end of the ED period. When final ED versus initial (2nd day) IT doses were assessed, the daily median dose ratios were 7.5 for total opiate and 4 for both spinal opiate and bupivacaine. Subsequently, lower daily volumes and higher concentrations were needed for IT administration of the drugs. During the first month of the IT treatment, sleeping and walking scores improved compared to ED treatment. Thus, the IT treatment gave more satisfactory pain relief, and--because of lower daily doses and volume--proved to be more suitable for treatment at home (continuous infusion from external pumps) than the ED treatment.

Adult↗
PubMed1990

Disturbances of blood-flow velocity in the dorsal veins of the hand after vein cannulation and cannula fixation in the anaesthetised patient.

Modifications of the mean blood-flow velocity in the dorsal veins of the hand were assessed semi-quantitatively with continuous wave (CW) Doppler equipment in 32 anaesthetised patients (17 men and 15 women), 23-78 (median = 56) years of age, before and after venous catheterisation with cannula fixation to the skin. Cannulation of the vein caused a 48% reduction in the mean blood-flow velocity and made it impossible to detect any flow with the equipment used in 22% of the patients. A 10% further reduction in the mean blood-flow velocity and in the number of subjects with undetectable blood flow was observed after fixation of the cannulae. Age, small vein diameter, and hyperventilation (end-tidal carbon dioxide less than or equal to 3.5 volume % appeared to be significant factors reducing blood-flow velocities in the cannulated veins. It is concluded that venous catheterisation and fixation of the cannula induce a significant reduction in the blood-flow velocity.

Adult↗
PubMed1990

Arginine catabolism by strains of oral streptococci.

Arginine catabolism via the arginine deiminase pathway was found in Streptococcus sanguis 903. Citrulline and ornithine were released from resting cells incubated with arginine, arginine-containing peptides, or saliva. Maximum arginine catabolism by resting cells of S. sanguis 903 was found in the pH range 7-8 and at 45-48 degrees C. Arginine deiminase activity was found in the cytoplasm and in the cell-wall extract of this strain, while ornithine carbamoyltransferase activity was found in the cytoplasm and in extracts of cell walls and cytoplasmic membranes. Streptococcus mutans GS-5 and Streptococcus sobrinus strains OMZ 176 and 6715 could release arginine from salivary peptides but were incapable of significant arginine catabolism.

Arginine↗
PubMed1989

The influence of Streptococcus mutans on adhesion of Candida albicans to acrylic surfaces in vitro.

Adhesion of Candida albicans and Streptococcus mutans was studied by incubation of radiolabelled cells with acrylic test specimens in a chemically defined growth medium. Strep. mutans adhered firmly in the presence of sucrose, while C. albicans was only loosely attached to the acrylic in both glucose and sucrose media. Firm adhesion of C. albicans occurred when the yeast was incubated simultaneously with Strep. mutans, in the presence of sucrose. The adhesion of C. albicans was also stimulated by incubation with Strep. mutans culture supernatants. Adhesion was not affected by the presence of partially purified glucosyltransferase from Strep. mutans IB. Coaggregation between C. albicans and Strep. mutans upon growth in sucrose medium was observed by light and scanning electron microscopy. No coaggregation was observed in the presence of glucose.

Bacterial Adhesion↗
PubMed1989

Cannula thrombophlebitis: a study in volunteers comparing polytetrafluoroethylene, polyurethane, and polyamide-ether-elastomer cannulae.

Cannulae made of polytetrafluoroethylene (PTFE: n = 11), thermoplastic polyether-urethane (TPEU: n = 11), and a new test material, polyamide-ether-elastomer (XLON: n = 10) were inserted into the veins of the dorsum of the hand in 32 healthy volunteers (10 women and 22 men), 21-50 years old. The cannulae were intended to be left in place for 5 days. No infusion was given and the dressings were not exchanged. The resulting thrombophlebitis, defined as two or more of the symptoms pain, redness, oedema and hardness, was estimated on a scale which took into account the incidence, location, intensity, and duration of the symptoms. Except for one volunteer in the XLON group, all the volunteers developed thrombophlebitis, generally observed on the third day of cannulation, and being more frequent and intense over the cannulae (P less than 0.001) and at the tip (P less than 0.01) than at the insertion sites. Pain and oedema were, on the whole, the most frequent and severe symptoms during the period of indwelling. After withdrawal, hardness was the most intense, and together with pain, the most long-lasting (up to 10 days) symptom. The differences between the materials in thrombophlebitis incidence and intensity were statistically significant only when each symptom was analysed separately. Thus, the PTFE cannulae caused more pain and hardness (probably because of greater platelet adhesion and a relatively greater stiffness), while the TPEU and XLON cannulae produced more periphlebitis (redness and oedema), probably because of potentially irritant and antigenic substances leaking from them (polyurethane oligomers and polyamide/polyethyleneglycol oligomers).

Adult↗
PubMed1989

Water-soluble glucans from Streptococcus mutans strain Ing-Britt as an energy source for bacterial growth.

Two fractions of water-soluble glucans with different molecular weight were produced by Streptococcus mutans IB. The larger glucan had a molecular weight of about 40,000. The molecular weight of the small glucan was estimated to be 4,100 by gel filtration chromatography and by biochemical methods. These glucans were tested for their ability to initiate and support growth of S. mutans IB and Streptococcus sanguis 903. S. sanguis 903 could grow with the low molecular weight glucan at a reduced rate compared with glucose. S. mutans IB could not utilize any of the glucans. No endo- or exo-glucanase activities could be detected in culture supernatants of any of the strains. In addition to maltose S. sanguis 903 could also utilize maltotriose, maltopentaose and maltoheptaose for growth while S. mutans IB could not grow with maltopentaose or maltoheptaose.

Chromatography, Gel↗
PubMed1988

Adhesion of Streptococcus rattus and Streptococcus mutans to metal surfaces.

The adhesion of Streptococcus rattus BHT and Streptococcus mutans IB to metal specimens of amalgam, silver, tin and copper was studied using (6-3H)thymidine labeled cells. In the standard assay the metal specimens were suspended by a nylon thread in an adhesion solution containing a chemically defined bacterial growth medium (FMC), sucrose, and radiolabeled bacteria. Maximum amounts of adhering bacteria were obtained after about 100 min of incubation. Saturation of the metal specimens with bacteria was not observed. Both strains also adhered in the absence of sucrose, indicating that glucan formation was not necessary for adhesion. However, in the presence of glucose, adhesion was only 26-45% of that observed in the presence of equimolar sucrose. Sucrose-dependent stimulation of adhesion seemed to be due to increased cell-to-cell adhesion capacity. Isolated radiolabeled water-insoluble and water-soluble polysaccharides produced from sucrose by S. rattus BHT were not adsorbed to the metal surfaces.

Absorption↗
PubMed1986

Estimation of central venous pressure by measurement of proximal axillary venous pressure using a "half-way" catheter.

The pressure in the proximal axillary vein (AVP) was compared with central venous pressure (CVP) in eight patients during and after elective abdominal surgery. Both pressures were recorded from soft, elastic, polyurethane catheters inserted in the basilic or cephalic veins ("half-way" catheters), punctured at the fossa cubiti (AVP), and via the right jugular vein (CVP). The AVP and CVP were recorded simultaneously using hydrostatic, conventional disposable venous pressure measurement sets. The measurements were performed during intermittent positive pressure ventilation with positive end-expiratory pressure from 0 to 7.5 cmH2O (0-0.74 kPa), as well as during spontaneous breathing. During both controlled and spontaneous respiration, small mean differences (0.2-1.0 cmH2O) (0.02-0.1 kPa), and a highly significant (P less than 0.001) positive correlation between CVP- and AVP-values were found. An increase of 1 cmH2O (0.10 kPa) in the CVP was associated with an increment of practically identical order (0.99-1.04 cmH2O) (0.10-0.11 kPa) in the AVP. The results suggest that monitoring of the AVP by a basilic "half-way" catheter produces diagnostic information similar to that from the measurement of the CVP from subclavian, external or internal jugular, as well as "long-way" brachial catheter, with no risk of the major mechanical complications which accompany the use of the latter catheters.

Adult↗
PubMed1986

Changes in specific gravity as a sign of disturbed brain maturation in protein-deprived rats.

The specific gravity of the cerebral cortex of normal and protein-deprived rats aged 15, 21 and 25 days was determined. The increase in specific gravity seen in control rats in the course of their development was reduced in protein-deprived rats in the course of the period between 15 and 21 days of age. The results are in agreement with previous reports on delayed maturation of the brain in protein-deprived rats and indicate that determination of brain specific gravity may serve as a suitable screening method in situations when a disturbed brain maturation is suspected.

Animals↗
PubMed1986

Exchange of occluded, tunnelled, subclavian central venous catheters. A technique reusing the existing tunnel.

A technique for the exchange of occluded, tunnelled, subclavian venous catheters reusing the existing tunnel is described. It was successfully used 14 times in 5 patients needing permanent parenteral nutrition at home, in whom insertion of a new catheter by another route would have been cumbersome and hazardous. The tunnel was opened below the clavicle, and the catheter clamped. The catheter was then cut close to the tunnel exist, and its distal part removed centrally through the opening at the clavicle. A guide wire was simultaneously pulled through. An introducer cannula was placed over the central part of the catheter into the subclavian vein, and the occluded catheter was withdrawn and a new one inserted. The latter was then guided through the tunnel by the guide wire. The catheter was then fixed, and the wound was closed and dressed. Prophylactic cloxacillin was given i.v. for 3 days. No bleeding, pulmonary embolism, local infection or sepsis were observed.

Adult↗
PubMed1986

Surface morphology of unused and used Hydromer-coated intravenous catheters.

Hydromer-coated polyurethane (Erythroflex) catheters, unused, or intravenously inserted for 2-20 days, were studied by scanning electron microscopy (SEM). Both unfixed and fixed (2% glutaraldehyde in phosphate buffer), and air-or critical-point dried (CPD) specimens were investigated. The catheter segments were sputter-coated with approx. 20 nm gold and studied at an accelerating voltage of 20 kV. The specimens were examined for surface depositions, thickness and structure of the Hydromer layers, and occurrence of adhering and embedded bacteria. The outer Hydromer layer showed, in the unused specimens, scratches and fissures, as well as adhering foreign bodies. In used specimens, the layer was swollen, with cracks (like "dried earth"), and, occasionally, amorphous substances and coccoid bacteria were seen adhering. Damage to the layer, or even its total disappearance was also noted in some specimens. The inner (luminal) Hydromer layer was, in unused specimens, clean and slightly wavy. In used catheters, it was thicker, possibly swollen, with small, isolated or agglomerated protrusions, like a "lunar landscape". Adhering platelets and amorphous substances were also occasionally seen. The results suggest that the Hydromer is a fragile material in both its dry and wet forms. Thus, the Hydromer-coated catheters should neither be stored in flexible packs, nor inserted by the Seldinger technique. The findings do not support the belief that the Hydromer-coating can prevent either thrombus formation, or intraluminal occlusion of the in-situ catheters.

Catheters, Indwelling↗