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Biomedical subjects

S Blomberg

Publications and source records attributed to S Blomberg.

At least 37 records · Page 2Linked to original sources
PubMed1990

Thoracic epidural anesthesia improves global and regional left ventricular function during stress-induced myocardial ischemia in patients with coronary artery disease.

The aim of the present investigation was to study the effects of high thoracic epidural anesthesia (TEA), including the cardiac sympathetic segments, on ischemic ST-segment changes and left ventricular global and regional wall motion abnormalities. Ten patients with a two- or three-vessel coronary artery disease, all treated with the beta-adrenergic blocker metoprolol because of severe stable angina pectoris, performed two identical exercise stress tests, the first without TEA (control exercise) and the second with TEA (TEA exercise). Before each stress test, intravenous metoprolol was given to achieve maximal or near maximal beta-adrenoceptor blockade. Systolic and diastolic arterial pressures (radial artery cannula), heart rate, and rate-pressure product, as well as global and regional ejection fractions, using equilibrium radionuclide angiography in the left anterior oblique projection, were measured at rest and during maximal exercise. ST-segment analysis (V3 or V5) was performed, and the regional wall motion score was calculated at control exercise and TEA exercise. Intravenous metoprolol or intravenous metoprolol plus TEA at rest did not cause any significant changes of any of the variables. During TEA exercise, systolic arterial pressure, diastolic arterial pressure, and rate-pressure product, but not heart rate, were significantly lower compared to control exercise. The global and anterolateral ejection fractions were significantly higher (52.8% versus 46.5% and 53.2% versus 46.0%, respectively, P less than 0.05), and the regional wall motion score was significantly lower (8.8 versus 11.8, P less than 0.01) during TEA exercise than during control exercise. ST-segment depression was significantly lower during TEA exercise (-1.03 versus -1.84 mV, P less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1989

Thoracic epidural anaesthesia in patients with unstable angina pectoris.

The effect of high thoracic epidural anaesthesia with intermittent epidural bolus injections of bupivacaine (2.5 or 5 mg ml-1) was studied in 28 patients with unstable angina pectoris. The majority of the patients had a history of previous acute myocardial infarction(s) and/or angina pectoris and severe coronary artery disease. All patients were treated with nitroglycerin infusion for greater than 24 h and were included in the study if they had chest pain, not caused by acute myocardial infarction, at bed rest or recurrent anginal pain at rest greater than 2 days after infarction. 4.4 +/- 0.3 ml of bupivacaine induced a blockade of the upper seven sympathetic segments (Th1-7) for 98 +/- 9 min. Heart rate decreased significantly from 70 +/- 3 to 64 +/- 3 beats min-1 while blood pressure was unaffected by thoracic epidural anaesthesia. In 27 patients (96%) the anaesthesia induced complete analgesia. Nitroglycerin infusion was discontinued definitely within 3 h in 26 patients (93%) and pain was thereafter controlled by means of thoracic epidural anaesthesia as the sole treatment in 23 patients (82%) and as the major treatment in 25 patients (89%). Twenty-one patients (75%) were fully mobilized and stabilized. Treatment with thoracic epidural anaesthesia lasted for 6.0 +/- 1.1 days. The number of daily epidural injections decreased significantly with time from 2.7 +/- 0.3 the first day to 0.9 +/- 0.3 the fourth day (P less than 0.01, n = 19). Two patients developed acute myocardial infarction during the anaesthesia treatment period, and one of these patients died.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

Thoracic epidural anesthesia and central hemodynamics in patients with unstable angina pectoris.

The effects of high thoracic epidural anesthesia (TEA) on central hemodynamics as measured by pulmonary arterial catheterization were studied in nine patients with severe coronary artery disease and unstable angina pectoris. The patients were also treated with a combination of beta-blockers, calcium antagonists, and nitrates, as well as salicylates, low-dose heparin, and nitroglycerin infusion for greater than 24 hr. Management of pain with high TEA was started with the bolus epidural injection of 4.3 +/- 0.2 mL bupivacaine (5 mg/mL), which induced a sympathetic blockade from Th. During ischemic chest pain, pulmonary artery and pulmonary capillary wedge pressures were significantly increased. TEA, while relieving the chest pain, significantly decreased systolic arterial blood pressure, heart rate, and pulmonary artery and pulmonary capillary wedge pressures, without any significant changes in coronary perfusion pressure, cardiac output, stroke volume, and systemic or pulmonary vascular resistances. In some patients, ST-segment depression was less pronounced during TEA. Thus, during ischemic chest pain, TEA has beneficial effects on the major determinants of myocardial oxygen consumption, without jeopardizing coronary perfusion pressure. TEA may therefore favorably alter the oxygen supply/demand ratio within ischemic myocardial areas.

Aged↗
PubMed1988

Thoracic epidural anesthesia in conscious and anaesthetized rats. Effects on central haemodynamics compared to cardiac beta adrenoceptor and ganglionic blockade.

A simple technique for cannulation of the thoracic epidural space in rats was described. 40-50 microliter of epidural bupivacaine 5 mg/ml induced a distribution of sensory analgesia from lower cervical to lower thoracic segments. With this model, effects of thoracic epidural anaesthesia (TEA) on mean arterial pressure (MAP), cardiac output (CO), systemic vascular resistance (SVR), stroke volume (SV), heart rate (HR), central venous pressure (CVP), left ventricular end-diastolic pressure (LVEDP) and maximal increase of pressure in the left ventricle (max dp/dt) were studied in six groups of animals: 1) In conscious animals (n = 10) MAP, CO, SV and HR decreased significantly by 12%, 25%, 10% and 16%, respectively, while SVR increased significantly by 20% during TEA; 2) In chloralose-anaesthetized animals (n = 7) the reduction in CO during TEA was less pronounced and there were no significant changes in SV or SVR; 3) In conscious animals (n = 6) LVEDP, CVP and max dp/dt decreased significantly during TEA; 4) Hexamethonium, when administered to pharmacologically vagotomized conscious animals during TEA (n = 8), induced a significant decrease in SVR (23%) but no change in HR; 5) Changes in haemodynamics after cardiac adrenoceptor blockade with metoprolol, in conscious animals (n = 12), did not differ significantly from those seen during TEA, except for an unchanged SV after metoprolol; 6) 50 microliters of bupivacaine (5 mg/ml) when given i.v. to conscious animals (n = 8) did not affect CO, SV, HR or TPR significantly, while MAP increased slightly but significantly. Thus, in this conscious animal model, TEA almost completely and rather selectively blocked probably mediated by a reflex activation of unblocked sympathetic efferents.(ABSTRACT TRUNCATED AT 250 WORDS)

Adrenergic beta-Antagonists↗
PubMed1988

Thoracic epidural anaesthesia decreases the incidence of ventricular arrhythmias during acute myocardial ischaemia in the anaesthetized rat.

The aim of the present investigation was to study the effect of high thoracic epidural anaesthesia (TEA) on the incidence of ventricular arrhythmias after ligation of the left coronary artery in chloralose-anaesthetized rats. Forty animals were randomly assigned to receive either 40-50 microliter of bupivacaine (5 mg/ml) or saline in implanted thoracic epidural catheters. TEA decreased mean arterial pressure (MAP) from 118 +/- 5 mmHg to 72 +/- 4 mmHg and heart rate (HR) from 450 +/- 9 to 387 +/- 8 beats/min, while epidural saline did not affect MAP and HR. In both groups coronary artery ligation induced a transient decrease in MAP within the first 5-10 min after ligation. In the control group HR increased, during the 30-min post-ligation period, from 453 +/- 9 to 474 +/- 10 beats/min (P less than 0.05) while no significant change was seen in the TEA group. In both groups the mortality rate was 10%. In the TEA group 30% and in the control group 0% had normal sinus rhythm during the recording period (P less than 0.001). The incidence of ventricular fibrillation and/or tachycardia was significantly lower (P less than 0.05) in the TEA group (20%) compared to the control group (53%). The incidence of ventricular extrasystoles did not differ between the two groups. We conclude that TEA-induced blockade of sympathetic afferents and efferents may offer protection against malignant ventricular arrhythmias in the early phase of acute myocardial infarction.

Anesthesia, Epidural↗
PubMed1987

Edentulousness--an oral handicap. Patient reactions to treatment with jawbone-anchored prostheses.

A questionnaire was sent to all 189 edentulous patients with denture adaptation problems who were treated with fixed prostheses on osseointegrated oral implants during the period 1965-1978. One hundred and fifty-two patients (80%) responded. Practically all had adapted well to the prostheses and were most satisfied with the rehabilitated oral function, including chewing ability. Four out of five patients regarded the bridge as part of their own body instead of a foreign object, and 90% would not hesitate to have the treatment performed again, if necessary. Parallel with the improved oral function the patients reported a definite reduction of psychosocial problems associated with their previous oral invalidity, and increased security and self-esteem.

Adult↗
PubMed1983

Psychological reactions to edentulousness and treatment with jawbone-anchored bridges.

Total edentulousness can lead to chewing problems as well as to feelings of insecurity and inferiority and considerable psycho-social problems. For many people a conventional removable denture is unsatisfactory. A new method - osseointegration - involves a titanium screw being operated into the jawbone and the attachment of a fixed bridge. In a controlled study, 26 patients were examined pre- and postoperatively 3 months and then 2 years after the insertion of a jawbone-anchored bridge. The majority of them state that there has been a significant improvement in their lives, that they have regained confidence in themselves, and that, in contrast to a conventional denture, they accept the fixed bridge as part of their body. More attention should be focused on psychological reactions to total edentulousness. Individuals who cannot be rehabilitated by means of conventional prosthetic procedures should be given the opportunity of having a jawbone-anchored bridge inserted. Such treatment means an odontological and psycho-social restitutio ad integrum.

Adaptation, Psychological↗
PubMed1980

Influence of maternal distress during pregnancy on fetal development and mortality.

The children of 1,263 women whose applications for legal abortion in 1960 had been refused, were compared with the next children born in the same delivery wards. Thus paired, matched controls were obtained and the children were compared with regard to height and weight in relation to gestational age, prematurity, perinatal mortality and mortality up to 12 years of age. There was a significantly lower number of stillbirths in the proband series, which is probably due to an increased number of abortions of less viable fetus. There were no differences in weight and height development, prematurity or neonatal and subsequent mortality.

Adolescent↗
PubMed1980

Influence of maternal distress during pregnancy on fetal malformations.

The aim of the study was to investigate whether emotional stress in a pregnant woman might have an adverse effect in the form of malformations on fetal development. The children of 1,263 women whose applications for legal abortion in 1960 had been refused were compared with the next children born in the same delivery wards and paired matched controls were thereby obtained. Results. 1) The incidence of malformations according to the criteria established by the Swedish Register of Malformations was 1.8% in the proband series as against 1.1% in the control series. 2) The incidence of malformation increased with higher age and lower social class in the proband series, whereas no such connection was found in the control series. 3) The incidence of malformations for children of abortion applicants 25 years of age and above from social class III was 3% in the proband series as against 0.6% in the control series (P = 0.017). 4) One malformation, cleft palate, occurred at a significantly (P less than 0.01) higher incidence than in the country as a whole, four cases against the expected value of 0.69. 5) Etiological analysis showed that three of the cases were chromosomal aberrations, all of them Down's syndrome, in two cases there was a genetic background and two cases were thalidomide-induced phocomelia. In three proband children there may have been a connection with the abuse of alcohol by the mother. 6) When the chromosomal, genetic and thalidomide cases are excluded, the preponderance of malformations in the proband children of mothers 25 years of age and above belonging to social class III still remains (2.2% vs. 0.3%, P = 0.017). Conclusion. The results may be seen as support for the hypothesis that emotional stress in a pregnant woman, operationally defined by the factor unwanted pregnancy, may interfere with fetal development and result in a higher incidence of malformations. The interference may occur directly via psycho-endocrinal or autonomous mechanisms or indirectly by the way in which the woman might act in this situation of stress, e.g. attempts to provoke abortion, neglect of proper food intake, excessive smoking, or the abuse of alcohol of drugs.

Abnormalities, Drug-Induced↗
PubMed1980

Influence of maternal distress during pregnancy on complications in pregnancy and delivery.

Children of women whose applications for legal abortion in 1960 had been refused were compared with the next children born in the same delivery wards, whose mothers were of similar age, parity and social class. 133 pairs thus matched were studied concerning the incidence of complications during pregnancy, delivery and puerperium. There were no statistically significant differences during either pregnancy, delivery or puerperium. The conclusion is that children of unwanted pregnancies do not run a greater risk of damage during delivery than the controls and the hypothesis of a negative influence due to an initially unwanted pregnancy was not supported.

Adolescent↗
PubMed1980

Influence of maternal distress during pregnancy on postnatal development.

Children of women whose applications for legal abortion in 1960 had been refused were compared with the next same-sexed children born in the same delivery wards, whose mothers were of similar age, parity and social class. The postnatal somatic and psychosocial development in 90 pairs thus matched was followed up to 15 years of age using school grades, the school health card and the register of the social welfare authorities. The initially unwanted children had a more insecure childhood with more cases of divorce. They performed worse at school and displayed more psychosomatic symptoms, they were more often registered with the social welfare authorities and in need of psychiatric treatment. When the 48 pairs that were formally equivalent as to having lived with their biological parents were compared the difference in school achievement remained. The result may be seen as support of the hypothesis of a negative prenatal influence.

Adolescent↗
PubMed1977

Enterotoxigenic Escherichia coli in Sweden.

The adrenal cell test for detection of heat-labile enterotoxin-producing Escherichia coli was performed on faecal specimens collected over a period of six months from 648 patients with diarrhoea. The patients came from all parts of Sweden. A total of 72 enterotoxigenic strains were found in 27 patients. Enterotoxigenic strains do not seem to be an important cause of diarrhoea in Sweden, since 70% of the patients with enterotoxin-producing strains had been abroad. Enterotoxigenic enterobacteria were the cause of traveller's diarrhoea in 11% of the patients who had been abroad with a peak incidence in July and August when traveller's diarrhoea was associated with enterotoxigenic strains in 17% of the patients. A simplified method for screening a large number of specimens for enterotoxin production was evaluated and found to be useful.

Enterotoxins↗