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Biomedical subjects

S Ström

Publications and source records attributed to S Ström.

At least 19 recordsLinked to original sources
PubMed2003

A comparison of propofol infusion and propofol/isoflurane anaesthesia in dexmedetomidine premedicated dogs.

The effects of propofol infusion were compared with propofol/isoflurane anaesthesia in six beagles premedicated with 10 microg/kg intramuscular (i.m.) dexmedetomidine. The suitability of a cold pressor test (CPT) as a stress stimulus in dogs was also studied. Each dog received isoflurane (end tidal 1.0%, induction with propofol) with and without CPT; propofol (200 microg/kg/min, induction with propofol) with and without CPT; premedication alone with and without CPT in a randomized block study in six separate sessions. Heart rate and arterial blood pressures and gases were monitored. Plasma catecholamine, beta-endorphin and cortisol concentrations were measured. Recovery profile was observed. Blood pressures stayed within normal reference range but the dogs were bradycardic (mean heart rate < 70 bpm). PaCO2 concentration during anaesthesia was higher in the propofol group (mean > 57 mmHg) when compared with isoflurane (mean < 52 mmHg). Recovery times were longer with propofol than when compared with the other treatments. The mean extubation times were 8 +/- 3.4 and 23 +/- 6.3 min after propofol/isoflurane and propofol anaesthesia, respectively. The endocrine stress response was similar in all treatments except for lower adrenaline level after propofol infusion at the end of the recovery period. Cold pressor test produced variable responses and was not a reliable stress stimulus in the present study. Propofol/isoflurane anaesthesia was considered more useful than propofol infusion because of milder degree of respiratory depression and faster recovery.

Anesthesia↗
PubMed1997

Colorectal cancer in patients over 75 years of age--determinants of outcome.

Two hundred and two consecutive patients with colorectal cancer, aged 75 years or older, diagnosed between 1980 and 1990, were followed up from the date of diagnosis until their death or until October 1994. Of these, 194 underwent some type of surgery, in 151 cases elective and in 43 emergency. The peri-operative mortality rate was 10.8% and the overall 5-year survival rate 28%. The ASA score was a predictor for both peri-operative mortality and survival. Peri-operative mortality was significantly increased among patients who had palliative operations, and those with post-operative complications and blood transfusions. Overall survival was worse for patients with absence of blood in the stools or absence of anaemia, for patients who lived in institutions pre-operatively, and for patients with advanced tumour stages. We conclude that the survival rate in elderly patients with colorectal cancer is acceptable after surgery. Old age is not a risk factor per se for peri-operative mortality or poor prognosis, and should not disqualify a person from operation.

Aged↗
PubMed1995

Respiratory monitoring during postoperative analgesia.

Respiratory monitoring, using a novel flow sensor based on an acoustic principle, has been investigated in 30 patients during postoperative analgesia. Each patient was subjected to monitoring and human observation for 8 hr. The study was performed by independent observers at three clinics. Significant correlation was noted between respiratory rate (RR) determined by the sensor and the observers. Recordings of respiratory duration index (RDI), breathing time intervals (BTIs) indicated high sensitivity of the instrument to respiratory depression and perturbations in the breathing rhythm. More than 800 apnea alarms were noted, using an alarm setting of 30 sec; 61% of the categorized alarms were noted by the observers as true apneas. From the recordings it was shown that the number of alarms can be reduced by a factor of four if the alarm setting is changed to 45 sec. We conclude that the suggested technique, with slight modifications, provides adequate respiratory monitoring of patients during postoperative analgesia.

Acoustics↗
PubMed1986

Creatine kinase and lactate dehydrogenase isoenzymes in stage D prostatic carcinoma.

Serum creatine kinase (CK) and lactate dehydrogenase (LD) isoenzymes were determined electrophoretically, along with various other biochemical markers of malignancy, in 19 patients with metastatic carcinoma of the prostate. Mitochondrial CK appeared in 15 patients, the CK-BB isoenzyme in 6. As a result, CK activity not inhibited by anti-M-subunit antibodies, CK non-M, was above the reference value in altogether 17 patients. There was a cathodic shift among the LD isoenzymes, significantly more prominent with increasing total LD, and a positive correlation between elevations of CK non-M and LD-5, suggesting a relation to tumour burden for both. An LD 'flip' (LD-1 greater than LD-2) was present in 10/15 patients. The frequency of CK non-M elevations was similar to--but not quantitatively correlated with--elevations of prostatic acid phosphatase and alkaline phosphatase. Thus, changes in CK and LD patterns are frequent in patients with prostatic cancer and must be taken into consideration when acute cardiac symptoms are evaluated in such patients.

Acid Phosphatase↗
PubMed1984

'Cardiac' enzymes after transurethral resection of the prostate.

Postoperative serial determinations of serum total creatine kinase (CK) and the CK-B subunit (by immunoinhibition), and of total lactate dehydrogenase (LD) and isoenzyme LD-1 (by immunoprecipitation), were performed in 16 and 9 patients, respectively, after uncomplicated transurethral resection of the prostate (TURP). Total CK remained unchanged. An early, modest increase in serum CK-B activity, accompanied by an unusually high CK-B/total CK relation, correlated significantly with duration of operation and amount of tissue resected. A slight, early elevation of the total LD level was not accompanied by an increase in LD-1. If the possibility of small increases in CK-B and LD from the prostate is taken into consideration, routine criteria for diagnosing myocardial damage may be applied after TURP.

Aged↗
PubMed1983

Serum creatine kinase (CK) activity after M-subunit inhibition in patients with atypical CK isoenzymes--a comparison to findings in acute myocardial infarction.

The serum levels of total creatine kinase (CK), and of CK-B, as estimated by the enzymatic anti-M-subunit immunoinhibition method, were studied in 14 patients with CK-B elevation associated with advanced malignant disease, in nine subjects with electrophoretically verified, immunoglobulin-bound CK-BB (macro CK) and in 28 patients with acute myocardial infarction (AMI). The range of CK-B activity was similar in all three groups. In AMI, the ratio CK-B/total CK at peak CK-B was less than 13% (mean 7%). In both the groups with atypical CK, the ratios varied from about 30% to nearly 100%, with a mean amounting to 2/3 of total CK activity. CK-B elevations in patients with untreated malignant tumours tended to increase with time, but occasionally remained fairly constant for months, like those in subjects with macro CK. Complementary CK isoenzyme separation, e.g. by electrophoresis, is needed to differentiate conditions with atypical CK activity, detected by routine use of CK-B determinations in the diagnosis of AMI.

Aged↗
PubMed1983

Serum creatine kinase isoenzymes in patients with advanced malignant disease.

Serum creatine kinase (CK) B subunit (CK-B) activity, as estimated by the enzymatic anti-M immunoinhibition method, and the CK isoenzyme pattern after agarose gel electrophoresis, were studied in 28 patients with advanced, untreated malignant disease. CK-B was above the decision limit, i.e. the discrimination limit used in the diagnosis of acute myocardial infarction (AMI), in 14 patients (50%). Electrophoresis demonstrated, besides CK-MM, an atypical, cathodically migrating CK band in 10 of these patients. This band may represent mitochondrial CK. The CK-BB isoenzyme was detected in 9 and CK-MB in 3 subjects. Histopathologic findings indicated that the occurrence of these isoenzymes was related to tumour burden and the overall severity of the disease. Survival among patients with CK-B elevation was shorter than among other patients. The present findings are relevant to the enzyme diagnosis of AMI and of potential significance for the evaluation of patients with known or suspected malignant tumours.

Creatine Kinase↗
PubMed1981

Diagnostic significance of serum CK-MB elevations following surgical damage to skeletal muscles.

Total creatine kinase (CK) and its isoenzyme MB (CK-MB) were studied in the serum of 14 patients following thoracotomy, mostly for pulmonary surgery, and in various thoracic muscles from another 9 patients subjected to the same procedure. CK-MB consistently appeared in the serum and was present in all muscle samples examined. CK-MB as a percentage of total CK (the CK-MB/CK ratio) was of similar order in serum and muscle, approximately 1.5%. Compared with previous findings after cardiopulmonary bypass surgery, maximum serum CK-MB activity occurred later, and the CK-MB levels as well as the CK-MB/CK ratio were considerably lower after non-cardiac thoracic surgery. It is suggested that the CK-MB/CK ratio 24 hours after operation may be used in the diagnosis of peri-operative myocardial infarction, particularly in non-cardiac surgery. After thoracotomy, this ratio was below 2.2%. In a series of patients with acute myocardial infarction, reported previously, the ratio was above 5.4%. Secondary rises of serum CK-MB following cardiac surgery should, apparently also be analysed in relation to the simultaneous total CK level.

Adult↗
PubMed1980

CK-MB in serum and in heart and skeletal muscles in patients subjected to mitral valve replacement.

Serum catalytic concentrations of total creatine kinase (CK) and its more heart-specific isoenzyme CK-MB were studied in 25 consecutive patients subjected to isolated mitral valve replacement (Björk--Shiley prosthesis). Heart and skeletal muscle CK and CK-MB content was determined in 10 cases. The postoperative serum levels did not reflect differences in myocardial CK-MB content between patients. CK-MB as a percentage of total CK at peak serum CK-MB (16 +/- 1%) (mean +/- SEM) was of similar order as the percentage of CK-MB in the myocardium (papillary muscle 20.9 +/- 1.3%, right auricle 18.2 +/- 0.5%). A small proportion of CK-MB was present in all skeletal muscle samples examined (diaphragm 4.2 +/- 0.6%, rectus abdominis 0.4 +/- 0.1%), indicating that the total CK level should also be taken into account in attempts to determine the origin of a raised postoperative serum CK-MB activity. The degree of postoperative CK-MB elevation was related to the duration of operation and of aortic cross-clamping. Perioperative myocardial infarction occurred in one patient, and serum CK-MB kinetics in this patient, with a biphasic enzyme curve, differed from those in the other patients.

Adult↗
PubMed1979

Prognostic significance of cardiopulmonary bypass time and postoperative serum enzyme levels in coronary surgery.

The serum activity concentrations of creatine kinase MB isoenzyme (CK-MB) after coronary bypass operations are correlated with the duration of extracorporeal circulation (ECC) and aortic cross-clamping (AC), and the kinetics of serum enzyme appearance in this situation differ from the findings in acute myocardial infarction, as shown in previous papers. In the present investigation, the functional significance of different levels of postoperative serum CK-MB activity was studied in 21 patients by clinical re-examination, including exercise test, after 18 months. The possible long-term effect of extended periods of ECC and AC was further evaluated in another series of 21 patients, with coronary angiography and heart catheterization performed before and one year after coronary surgery. It is concluded that if successful revascularization is achieved by operation, the duration of ECC and AC, and the magnitude of postoperative CK-MB release, appear to have no significance for future myocardial function.

Angina Pectoris↗
PubMed1979

Serum enzymes with special reference to CK-MB following coronary bypass surgery.

In a consecutive series of 25 coronary bypass operations, the postoperative serum activity levels of total creatine kinase (CK) and its more heart-specific isoenzyme CK-MB were examined and related to the levels of aspartate aminotransferase (ASAT), alanine aminotransferase (ALAT) and thermostable lactate dehydrogenase (LD-T), to electrocardiographic (ECG) findings and to surgical characteristics. Detectable CK-MB activity was found in all patients, usually appearing while the operation was still in progress. Peak CK-MB occurred earlier than peak total CK. There was no ECG evidence of myocardial infarction in any patient. The degree of postoperative CK-MB elevation, however, correlated to the duration of extracorporeal circulation (ECC) and aortic cross-clamping (AC). After 120 min of ECC and 70 min of AC, release of CK-MB, as well as of the other enzymes studied, increased considerably. There was a significant correlation between high CK-MB activity and high early postoperative activities of total CK, ASAT and LD-T. When CK-MB determinations are not available, ASAT is preferable to total CK or LD-T in the early evaluation of operative myocardial injury. From the fourth postoperative day, only LD-T is informative in this respect; a second rise of ASAT and ALAT is probably of hepatic origin.

Adult↗
PubMed1979

Serum CK-MB kinetics in acute myocardial infarction and after coronary bypass operations.

Serum creatine kinase (CK) isoenzyme MB and total CK activity concentrations in 11 patients with acute myocardial infarction (AMI) were compared with the corresponding enzyme activities in 25 patients after coronary bypass surgery, not complicated clinically by AMI. Peak CK-MB occurred 2 +/- 0 (mean +/- SEM) hours after the end of surgery (mean duration of operation 6 hours), but 17 +/- 1 hours from the onset of symptoms in AMI. The plasma half"life for CK-MB was 11 +/- 1 hours under both conditions. Peak total CK was found after about 20 hours in both series of patients. Total CK half-life was 17 +/- 2 hours in AMI, but 30 +/- 3 hours following surgery. CK kinetics were thus different in these two situations, indicating different mechanisms for the elevations of serum CK-MB activity. In conclusion, the time course for the transient CK-MB elevation following bypass surgery should be considered in the diagnosis of peri operative infarction.

Acute Disease↗
PubMed1977

Health care and hospital pharmacy in Sweden.

Health care and hospital pharmacy in Sweden are discussed. The system of drug distribution in Sweden is reviewed, and the following functions of hospital pharmacies are discussed; drug and hygiene committees, inspection activities, drug information and educational services, radiopharmacy, and research activities. Pharmacy education, drug manufacturing, and Apoteksbolaget--The National Corporation of Swedish Pharmacies--are also discussed. Future developments in hospital pharmacy are expected to include increased sales to outpatients, a restructuring of the drug supply within outpatient care and recommendations from the hospital drug committees on outpatient care.

Delivery of Health Care↗