Pub Date : 1997-01-01DOI: 10.1111/j.1399-6576.1997.tb05539.x
H Seeman-Lodding, B Biber, S Häggmark, C Jern, S Jern, G Johansson, O Winsö
Anesthesia and surgery influences regional net release and uptake rates of tissue-type plasminogen activator. An experimental study in the intact pig
{"title":"Anesthesia and surgery influences regional net release and uptake rates of tissue-type plasminogen activator. An experimental study in the intact pig.","authors":"H Seeman-Lodding, B Biber, S Häggmark, C Jern, S Jern, G Johansson, O Winsö","doi":"10.1111/j.1399-6576.1997.tb05539.x","DOIUrl":"https://doi.org/10.1111/j.1399-6576.1997.tb05539.x","url":null,"abstract":"Anesthesia and surgery influences regional net release and uptake rates of tissue-type plasminogen activator. An experimental study in the intact pig","PeriodicalId":75373,"journal":{"name":"Acta anaesthesiologica Scandinavica. Supplementum","volume":"110 ","pages":"151-3"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1399-6576.1997.tb05539.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20190813","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1997-01-01DOI: 10.1111/j.1399-6576.1997.tb05516.x
M Hayes
Total body oxygen consumption 0702) is a measure of global aerobic metabolism and it has been suggested that an inability to consume oxygen is the best early predictor of organ failure1. V02 is however, dependent on metabolic demands, which may vary widely in critically ill patients and there has therefore been considerable interest in using the relationship between oxygen delivery (DO21 and V02 as a means of evaluating the adequacy of tissue oxygenation. A number of studies have demonstrated that in apparently stable critically ill patients, in contrast to normal physiology, V02 increases when DO2 is augmented and falls in response to reductions in D022,3. Characteristically this phenomenon, termed supply dependency, is associated with increased oxygen demand, a diminished ability of the tissues to alter oxygen extraction in response to a change in DO2 and the presence of raised lactate levels. The demonstration of supply dependency has been regarded as indi4 rect evidence of occult tissue oxygen debt and associated with a high mortality. In contrast, in some recent studies although an oxygen flux test was not specifically performed, the ability to increase VO2 when DO2 was enhanced was associated with survival, whereas in those in whom V02 was unresponsive to increases in DO2 had persistently elevated lactate concentrations and an extremely poor prognosis5.6. Studies investigating the relationship between DO2 and V02 are complicated by many factors including; mathematical coupling7; the spontaneous fluduations in V02 and DO2 in apparently stable critically ill patients8; and the effect of catecholamines on oxidative metabolism which can lead to increases in V029. Recent work has even suggested that the critical level of oxygen delivery is much lower than that previously reported in normal humans and perhaps surprisingly is not altered by sepsislO. The uncertainty surrounding supply dependency and the knowledge that the critical level of oxygen delivery may not be altered by sepsis undermines the basis for goal directed therapy in critically ill patients. It is now clear that outcome of this group of patients is worsened when aggressive treatment with inotropes is directed towards attaining supranormal levels of both oxygen delivery and consumption. It is also understood that it is the ability to attain a hypermetabolic state with elevated levels of cardiac index, D02, and V02 that is associated with a good outcome. Administration of very small doses of endotoxin to normal human volunteers produces a significant increase in both DO2 and VO2l1. Patients with uncomplicated sepsis have a greater capacity to extract oxygen (and consequently a higher V02) despite a lower cardiac index and DO2 than more severely ill patients with sepsis syndrome12. Hypermetabolism therefore appears to be an important component of a successful host response particularly in sepsis. In rats made septic by caecal ligation and puncture, those who survived remained hypermet
{"title":"Therapeutic aspects of oxygen utilisation.","authors":"M Hayes","doi":"10.1111/j.1399-6576.1997.tb05516.x","DOIUrl":"https://doi.org/10.1111/j.1399-6576.1997.tb05516.x","url":null,"abstract":"Total body oxygen consumption 0702) is a measure of global aerobic metabolism and it has been suggested that an inability to consume oxygen is the best early predictor of organ failure1. V02 is however, dependent on metabolic demands, which may vary widely in critically ill patients and there has therefore been considerable interest in using the relationship between oxygen delivery (DO21 and V02 as a means of evaluating the adequacy of tissue oxygenation. A number of studies have demonstrated that in apparently stable critically ill patients, in contrast to normal physiology, V02 increases when DO2 is augmented and falls in response to reductions in D022,3. Characteristically this phenomenon, termed supply dependency, is associated with increased oxygen demand, a diminished ability of the tissues to alter oxygen extraction in response to a change in DO2 and the presence of raised lactate levels. The demonstration of supply dependency has been regarded as indi4 rect evidence of occult tissue oxygen debt and associated with a high mortality. In contrast, in some recent studies although an oxygen flux test was not specifically performed, the ability to increase VO2 when DO2 was enhanced was associated with survival, whereas in those in whom V02 was unresponsive to increases in DO2 had persistently elevated lactate concentrations and an extremely poor prognosis5.6. Studies investigating the relationship between DO2 and V02 are complicated by many factors including; mathematical coupling7; the spontaneous fluduations in V02 and DO2 in apparently stable critically ill patients8; and the effect of catecholamines on oxidative metabolism which can lead to increases in V029. Recent work has even suggested that the critical level of oxygen delivery is much lower than that previously reported in normal humans and perhaps surprisingly is not altered by sepsislO. The uncertainty surrounding supply dependency and the knowledge that the critical level of oxygen delivery may not be altered by sepsis undermines the basis for goal directed therapy in critically ill patients. It is now clear that outcome of this group of patients is worsened when aggressive treatment with inotropes is directed towards attaining supranormal levels of both oxygen delivery and consumption. It is also understood that it is the ability to attain a hypermetabolic state with elevated levels of cardiac index, D02, and V02 that is associated with a good outcome. Administration of very small doses of endotoxin to normal human volunteers produces a significant increase in both DO2 and VO2l1. Patients with uncomplicated sepsis have a greater capacity to extract oxygen (and consequently a higher V02) despite a lower cardiac index and DO2 than more severely ill patients with sepsis syndrome12. Hypermetabolism therefore appears to be an important component of a successful host response particularly in sepsis. In rats made septic by caecal ligation and puncture, those who survived remained hypermet","PeriodicalId":75373,"journal":{"name":"Acta anaesthesiologica Scandinavica. Supplementum","volume":"110 ","pages":"99-100"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1399-6576.1997.tb05516.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20192814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1997-01-01DOI: 10.1111/j.1399-6576.1997.tb05518.x
D Bevan
{"title":"Reversal of neuromuscular block: the case FOR reversal.","authors":"D Bevan","doi":"10.1111/j.1399-6576.1997.tb05518.x","DOIUrl":"https://doi.org/10.1111/j.1399-6576.1997.tb05518.x","url":null,"abstract":"","PeriodicalId":75373,"journal":{"name":"Acta anaesthesiologica Scandinavica. Supplementum","volume":"110 ","pages":"102"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1399-6576.1997.tb05518.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20192816","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1997-01-01DOI: 10.1111/j.1399-6576.1997.tb05524.x
U Lendahl
The transgenic technique allows specific genetic alterations to be made in all cells of an animal and this has greatly improved our understanding of how the embryonic and adult central nervous system (CNS) develop. The CNS originates from the neuroectoderm in the neural plate on the dorsal side of the embryo and after closure of the neural tube the cells of the neuroepithelium, i.e. the CNS stem cells, transiently proliferate to generate neurons and glial cells. Here we review our attempts to gain insights into the control of CNS development. We have identified a gene, nestin, which is predominantly expressed in embryonic and adult CNS stem cells. In addition to its normal expression in the CNS stem cells, nestin is reexpressed in CNS tumors and in the adult spinal cord and brain after CNS injury. By using the lacZ reporter gene assay in transgenic mice, we have identified regulatory regions (enhancer) in the nestin gene required for expression in embryonic CNS stem cells and in the adult spinal cord after injury. In a second project, we have cloned and characterized the Notch gene family (the Notch 1, 2 and 3 genes) in mouse and man. These genes encode trans-membrane receptors, which appear to be key regulatory molecules for proliferation and differentiation both in the developing CNS and in other tissues. Expression of an activated form of the Notch 3 receptor from the nestin promoter in transgenic mice leads to a lethal, exencephaly-like phenotype in the embryo, probably as a result of excess proliferation of the CNS stem cells. The recent finding that the Notch 3 gene is the genetic cause for familial stroke is discussed in the context of current models for Notch function.
{"title":"Transgenic analysis of central nervous system development and regeneration.","authors":"U Lendahl","doi":"10.1111/j.1399-6576.1997.tb05524.x","DOIUrl":"https://doi.org/10.1111/j.1399-6576.1997.tb05524.x","url":null,"abstract":"<p><p>The transgenic technique allows specific genetic alterations to be made in all cells of an animal and this has greatly improved our understanding of how the embryonic and adult central nervous system (CNS) develop. The CNS originates from the neuroectoderm in the neural plate on the dorsal side of the embryo and after closure of the neural tube the cells of the neuroepithelium, i.e. the CNS stem cells, transiently proliferate to generate neurons and glial cells. Here we review our attempts to gain insights into the control of CNS development. We have identified a gene, nestin, which is predominantly expressed in embryonic and adult CNS stem cells. In addition to its normal expression in the CNS stem cells, nestin is reexpressed in CNS tumors and in the adult spinal cord and brain after CNS injury. By using the lacZ reporter gene assay in transgenic mice, we have identified regulatory regions (enhancer) in the nestin gene required for expression in embryonic CNS stem cells and in the adult spinal cord after injury. In a second project, we have cloned and characterized the Notch gene family (the Notch 1, 2 and 3 genes) in mouse and man. These genes encode trans-membrane receptors, which appear to be key regulatory molecules for proliferation and differentiation both in the developing CNS and in other tissues. Expression of an activated form of the Notch 3 receptor from the nestin promoter in transgenic mice leads to a lethal, exencephaly-like phenotype in the embryo, probably as a result of excess proliferation of the CNS stem cells. The recent finding that the Notch 3 gene is the genetic cause for familial stroke is discussed in the context of current models for Notch function.</p>","PeriodicalId":75373,"journal":{"name":"Acta anaesthesiologica Scandinavica. Supplementum","volume":"110 ","pages":"116-8"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1399-6576.1997.tb05524.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20192823","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 1997-01-01DOI: 10.1111/j.1399-6576.1997.tb05527.x
U Ungerstedt
Microdialysis is a technique for sampling the chemistry of essentially all organs and tissues of the body. It was conceived of in the early 70th by Delgado's group in the USA and our group in Sweden. The idea was to implant an "artificial blood capillary" in the tissue, perfuse it with a physiological solution, recover molecules that diffuse over the membrane, and analyse the dialysate. The technique is now universally accepted for investigations of the brain and peripheral organs in animals and more than 4000 papers are published using the technique in essentially every organ of the body. The first implantation of microdialysis catheters in human subcutaneous and brain tissue were made ten years ago at the Karolinska institute in order to follow tissue metabolism. The lack of available instruments slowed the development of the technique. However, two years ago suitable catheters, a portable microdialysis pump and a bedside analyser became available. Today more than 200 papers are published on human investigations mainly in the field of diabetes, adipous tissue metabolism, neuro intensive and neonatal care. The microdialysis catheter is a flexible concentric catheter covered with a 10-30 mm dialysis membrane distally. An inlet tube connects to a small portable pump and the outlet tube to a microvial holder. There is one catheter intended for implantation into subcutaneous tissue or resting muscle and another for implantation into the brain. In the clinical situation the microvial is usually changed every 1W min and the sample analysed in the bedside analyser and then often brought to the laboratory for a more extensive analysis of various analytes. The usefulness of microdialysis rests on two features of the technique: 1) It samples the chemistry in individual tissues and organs as opposed from blood samples and 2) It allows very frequent sampling without any removal of blood or tissue from the body. In the first case microdialysis represent a new and unique possibility to follow tissue metabolism, for example during hypoxia or ischemia as well as the local concentration of drugs and other exogenuous substances. In the second case it is a well tolerated technique for monitoring, for example, a diabetes patient in order to adjust insulin treatment or a neonate where frequent blood sampling is a severe problem. There is a strong interest for applying microdialysis in various clinical situations: In vascular and plastic surgery for monitoring preand postsurgical tissue metabolism. In intensive care for monitoring metabolism after multi trauma and sepsis. In neurointensive care for monitoring brain trauma and hemorrhage. In neonates for minimizing blood samp ling and during and between hemodialysis treatments for monitoring tissue urea. The analytes of immediate interest for bedside monitoring are glucose, lactate, pyruvate, glycerol, glutamate and urea. The lactate/pyruvate ratio is of particular interest for distinguishing hypermetabolism from hypo
{"title":"Microdialysis--a new technique for monitoring local tissue events in the clinic.","authors":"U Ungerstedt","doi":"10.1111/j.1399-6576.1997.tb05527.x","DOIUrl":"https://doi.org/10.1111/j.1399-6576.1997.tb05527.x","url":null,"abstract":"Microdialysis is a technique for sampling the chemistry of essentially all organs and tissues of the body. It was conceived of in the early 70th by Delgado's group in the USA and our group in Sweden. The idea was to implant an \"artificial blood capillary\" in the tissue, perfuse it with a physiological solution, recover molecules that diffuse over the membrane, and analyse the dialysate. The technique is now universally accepted for investigations of the brain and peripheral organs in animals and more than 4000 papers are published using the technique in essentially every organ of the body. The first implantation of microdialysis catheters in human subcutaneous and brain tissue were made ten years ago at the Karolinska institute in order to follow tissue metabolism. The lack of available instruments slowed the development of the technique. However, two years ago suitable catheters, a portable microdialysis pump and a bedside analyser became available. Today more than 200 papers are published on human investigations mainly in the field of diabetes, adipous tissue metabolism, neuro intensive and neonatal care. The microdialysis catheter is a flexible concentric catheter covered with a 10-30 mm dialysis membrane distally. An inlet tube connects to a small portable pump and the outlet tube to a microvial holder. There is one catheter intended for implantation into subcutaneous tissue or resting muscle and another for implantation into the brain. In the clinical situation the microvial is usually changed every 1W min and the sample analysed in the bedside analyser and then often brought to the laboratory for a more extensive analysis of various analytes. The usefulness of microdialysis rests on two features of the technique: 1) It samples the chemistry in individual tissues and organs as opposed from blood samples and 2) It allows very frequent sampling without any removal of blood or tissue from the body. In the first case microdialysis represent a new and unique possibility to follow tissue metabolism, for example during hypoxia or ischemia as well as the local concentration of drugs and other exogenuous substances. In the second case it is a well tolerated technique for monitoring, for example, a diabetes patient in order to adjust insulin treatment or a neonate where frequent blood sampling is a severe problem. There is a strong interest for applying microdialysis in various clinical situations: In vascular and plastic surgery for monitoring preand postsurgical tissue metabolism. In intensive care for monitoring metabolism after multi trauma and sepsis. In neurointensive care for monitoring brain trauma and hemorrhage. In neonates for minimizing blood samp ling and during and between hemodialysis treatments for monitoring tissue urea. The analytes of immediate interest for bedside monitoring are glucose, lactate, pyruvate, glycerol, glutamate and urea. The lactate/pyruvate ratio is of particular interest for distinguishing hypermetabolism from hypo","PeriodicalId":75373,"journal":{"name":"Acta anaesthesiologica Scandinavica. Supplementum","volume":"110 ","pages":"123"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1111/j.1399-6576.1997.tb05527.x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20192825","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Regional anesthesia in the elderly: indications and contraindications.","authors":"I Schindler","doi":"","DOIUrl":"","url":null,"abstract":"","PeriodicalId":75373,"journal":{"name":"Acta anaesthesiologica Scandinavica. Supplementum","volume":"111 ","pages":"209-11"},"PeriodicalIF":0.0,"publicationDate":"1997-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"20349906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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