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  • 1. Abu-Zidan, FM
    et al.
    Siosteen, AK
    Wang, Jianpu
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Kirurgi.
    Al-Ayoubi, Fawzi
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för biomedicin och kirurgi.
    Lennquist, Sten
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Kirurgi. Östergötlands Läns Landsting, Katastrofmedicinskt centrum.
    Establishment of a teaching animal model for sonographic diagnosis of trauma2004Inngår i: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 56, nr 1, s. 99-104Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Ultrasound is widely accepted as a valuable diagnostic tool for detecting intra-abdominal and intrathoracic bleeding in trauma patients. Nevertheless, many doctors are reluctant to use it because they do not have sufficient training. This study aimed to define intraabdominal and intrathoracic fluid volumes that can be detected by sonography and their relation to fluid width in pigs to establish a clinically relevant animal model for teaching and training. Methods: Different volumes of normal saline were infused into the abdomen (50-2,000 mL) and chest (25-250 mL) in five anesthetized pigs. The maximum width of fluid as detected by ultrasound was recorded. The right upper quadrant, left upper quadrant, pelvis, and right paracolic section of the abdomen and right pleural cavity were studied. An experienced radiologist performed the studies. The effects on respiratory and cardiovascular functions were evaluated. Results: The sonographic findings in the pig were similar to those in humans. Up to 50 mL of intra-abdominal fluid and up to 25 mL of intrathoracic fluid could be detected by ultrasound. There was a significant correlation between the volume infused and the fluid width detected. The respiratory and cardiovascular monitoring of the animals showed that the infused intrathoracic volumes mimicked a survivable hemothorax. Conclusion: The pig may serve as an excellent clinically relevant model with which to teach surgeons detection of different volumes of intra-abdominal and intrathoracic fluids. The value of this model as an educational tool has yet to be tested.

  • 2.
    Bak, Zoltan
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Anestesi- och operationscentrum, Operationskliniken US.
    Sjöberg, Folke
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Brännskadevård. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Eriksson, Olle
    Linköpings universitet, Institutionen för datavetenskap, Statistik. Linköpings universitet, Filosofiska fakulteten.
    Steinvall, Ingrid
    Linköpings universitet, Institutionen för klinisk och experimentell medicin. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Rekonstruktionscentrum, Hand- och plastikkirurgiska kliniken US.
    Janerot Sjöberg, Birgitta
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk fysiologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Hjärtcentrum, Fysiologiska kliniken.
    Hemodynamic Changes During Resuscitation After Burns Using the Parkland Formula2009Inngår i: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 66, nr 2, s. 329-336Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The Parkland formula (2-4 mL/kg/burned area of total body surface area %) with urine output and mean arterial pressure (MAP) as endpoints; for the fluid resuscitation in burns is recommended all over the world. There has recently been a discussion on whether central circulatory endpoints should be used instead, and also whether volumes of fluid should be larger. Despite this, there are few central hemodynamic data available in the literature about the results when the formula is used correctly.

    Methods: Ten burned patients, admitted to our unit early, and with a burned area of >20% of total body sur-face area were investigated at 12, 24, and 36 hours after injury. Using transesophageal echocardiography, pulmonary artery catheterization, and transpulmonary thermodilution to monitor them, we evaluated the cardiovascular coupling when urinary output and MAP were used as endpoints.

    Results: Oxygen transport variables, heart rate, MAP, and left ventricular fractional area, did not change significantly during fluid resuscitation. Left ventricular end-systolic and end-diastolic area and global end-diastolic volume index increased from subnormal values at 12 hours to normal ranges at 24 hours after the burn. Extravascular lung intrathoracal blood volume ratio was increased 12 hours after the burn.

    Conclusions: Preload variables, global systolic function, and oxygen transport recorded simultaneously by three separate methods showed no need to increase the total fluid volume within 36 hours of a major burn. Early (12 hours) signs of central circulatory hypovolemia, however, support more rapid infusion of fluid at the beginning of treatment.

  • 3.
    Drobin, Dan
    et al.
    South Hospital, Stockholm, Sweden.
    Sjöstrand, Fredrik
    South Hospital, Stockholm, Sweden.
    Piros, David
    South Hospital, Stockholm, Sweden.
    Hedin, Annika
    South Hospital, Stockholm, Sweden.
    Heinius, Göran
    South Hospital, Stockholm, Sweden.
    Hahn, Robert G
    South Hospital, Stockholm, Sweden.
    Tranexamic acid does not prevent rebleeding in an uncontrolled hemorrhage porcine model2005Inngår i: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 59, nr 4, s. 976-983Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: Fluid resuscitation after uncontrolled hemorrhage might promote rebleeding and irreversible shock. Tranexamic acid is a procoagulant drug that limits blood loss after surgery of the hip, knee, and heart. We hypothesized that pretreatment with tranexamic acid reduces the rebleeding in uncontrolled hemorrhage and thereby allows safe administration of crystalloid fluid resuscitation.

    METHODS: A 120-minute intravenous infusion of 100 mL/kg of Ringer's solution was given to 24 pigs (mean weight, 20 kg) 10 minutes after lacerating the infrarenal aorta. The animals were randomized to receive an intravenous injection of 15 mg/kg of tranexamic acid or placebo just before starting the resuscitation. Rebleeding events were monitored by two ultrasonic probes positioned proximal and distal to the laceration.

    RESULTS: Tranexamic acid had no effect on the number of rebleeding events, bled volume, or mortality. The initial bleeding stopped within 4 minutes after the injury. The five animals that died suffered from 4.4 rebleeding events on average, which tripled the total blood loss, whereas the survivors had only 1.3 such events during fluid resuscitation (p < 0.02). At autopsy, death was associated with a larger total hemorrhage; the blood recovered from the abdomen weighed 1.4 kg (median) in nonsurvivors and 0.6 kg in survivors (p < 0.001), with the difference being attributable to rebleeding.

    CONCLUSION: Rebleeding events increased the amount of blood lost and the mortality in uncontrolled aortic hemorrhage. Tranexamic acid offered no benefit.

  • 4.
    Lennquist, Sten
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för klinisk och experimentell medicin, Kirurgi. Östergötlands Läns Landsting, Katastrofmedicinskt centrum.
    Management of major accidents and disasters: An important responsibility for the trauma surgeons2007Inngår i: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 62, nr 6, s. 1321-1329Artikkel i tidsskrift (Fagfellevurdert)
  • 5.
    Metcalf, Kerstin
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Anestesiologi med intensivvård. Linköpings universitet, Hälsouniversitetet.
    Berg, Anna
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Cellbiologi. Linköpings universitet, Hälsouniversitetet.
    Ericson, Ann-Charlott
    Linköpings universitet, Institutionen för biomedicin och kirurgi, Cellbiologi. Linköpings universitet, Hälsouniversitetet.
    Lisander, Björn
    Linköpings universitet, Institutionen för medicin och vård, Anestesiologi. Linköpings universitet, Hälsouniversitetet.
    Nitric oxide does not cause extravasation in endotoxemic rats2005Inngår i: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 58, nr 5, s. 1047-1054Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Nitric oxide (NO) formed from inducible NO synthase (iNOS) is assumed to promote vascular permeability in sepsis and endotoxemia.

    Methods: Thirty-seven anesthetized rats were examined for the effects of endotoxin. After randomization, 17 animals had lipopolysaccharide (LPS) administered and 20 rats served as controls and were given the corresponding volume of saline. The observation period was 5 hours after administration of endotoxin. Mean arterial blood pressure, heart rate, and hematocrit were recorded in all animals, and transcapillary exchange of albumin, tissue water content, immunohistochemistry for nitric oxide synthase, and blood gases were investigated in subsets of animals.

    Results: When anesthetized rats were studied for 5 hours after endotoxin (LPS), the sequestration of albumin decreased in the intestine (double-isotope method) and there was no increased water content (freeze-drying technique) when the elevated tissue plasma volume of the LPS-treated rats was corrected for. Immunohistochemical methods showed a similar distribution and intensity of staining for endothelial NOS and neuronal NOS in LPS and control groups. In the lung of the LPS-treated rats, there was a significantly larger number of infiltrating, inflammatory cells staining for iNOS. There was no iNOS demonstrated in vascular structures or heart.

    Conclusion: At 5 hours after LPS, there was no increased loss of water or albumin from the circulation. This challenges the notion that NO causes vascular damage in endotoxemia and extravasation as an obligatory sequela to endotoxemia.

  • 6.
    Olofsson, Pia
    et al.
    Linköpings universitet, Institutionen för biomedicin och kirurgi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Kirurgi- och onkologicentrum, Kirurgiska kliniken i Östergötland med verksamhet i Linköping, Norrköping och Motala.
    Abu-Zidan, Fikri M
    Trauma Group, Faculty of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
    Wang, Jianpu
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Katastrofmedicin. Linköpings universitet, Hälsouniversitetet.
    Nagelkerke, Nico
    Department of Community Medicine, Faculty of Medicine and Health Sciences, UAE University, Al-Ain, United Arab Emirates.
    Lennquist, Sten
    Linköpings universitet, Institutionen för biomedicin och kirurgi. Linköpings universitet, Hälsouniversitetet.
    Wikstrom, Thore
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Katastrofmedicin. Linköpings universitet, Hälsouniversitetet.
    The effects of early rapid control of multiple bowel perforations after high-energy trauma to the abdomen: implications for damage control surgery2006Inngår i: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 61, nr 1, s. 185-191Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    BACKGROUND: This study evaluates the effects of early rapid control of multiple bowel perforations on cardiovascular and pulmonary function in high-energy traumatic shock compared with conventional small bowel resection anastomosis.

    METHODS: Fifteen anesthetized pigs, 10 to 12 weeks old, were exposed to a reproducible high-energy trauma and were divided into two groups. In the first group, the resection anastomosis group (RA, n = 8), small-bowel injuries were treated with resection and anastomosis; in the second group, the multiple bowel ligation group (BL, n = 7), small-bowel injuries were treated by resection and ligation. Repeated measurement analysis of variance was used to study the within group change overtime, the between group difference, and the interaction between them. Mean outcome measures were intravascular pressures, cardiac output, vascular resistance, lactic acid, and blood gases.

    RESULTS: The high-energy injuries caused traumatic shock in both groups with reduced cardiac output (p < 0.001) and lactic acidemia (p < 0.001). The BL group had a trend for higher cardiac output (p = 0.06). The rise in systemic and pulmonary vascular resistance was significantly reduced in the BL group compared with the RA group (p < 0.05). The BL group had a strong trend for higher oxygen extraction ratio (p = 0.06). There was a trend for less oxygen consumption in the BL group (p = 0.07). There was no difference in the lactic acidemia between the two groups.

    CONCLUSIONS: Early rapid control of multiple bowel perforations after high-energy trauma resulted in less impairment of cardiovascular function than conventional resection anastomosis of the bowel.

  • 7.
    Wang, Jianpu
    et al.
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum, Katastrofmedicinskt centrum. Linköpings universitet, Hälsouniversitetet.
    Zheng, Limin
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum, Katastrofmedicinskt centrum. Linköpings universitet, Hälsouniversitetet.
    Walther, Sten
    Östergötlands Läns Landsting, Katastrofmedicinskt centrum, Katastrofmedicinskt centrum. Linköpings universitet, Hälsouniversitetet.
    Administration of aerosolized terbutaline and budesonide reduces chlorine gas-induced acute lung injury2004Inngår i: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 56, nr 4, s. 850-862Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: The pathophysiology and treatment of chlorine gas-induced acute lung injury is poorly characterized and based on anecdotal data. This study aimed to assess the effects of aerosolized beta-2 adrenergic agonist and corticosteroid therapy on chlorine gas-induced lung injury.

    Methods: Anesthetized, ventilated pigs were exposed to chlorine gas (400 parts per million for 20 minutes), then assigned randomly 30 minutes later to receive aerosolized terbutaline, budesonide, terbutaline followed by budesonide or placebo (6 pigs in each group). Hemodynamics, gas exchange, and lung mechanics were evaluated for another 5 hours.

    Results: All the animals demonstrated an immediate increase in airway and pulmonary artery pressure as well as sharp drops in arterial oxygen tension (PaO2) and lung compliance (C L). Recovery of PaO2 and CL was greatest in the terbutaline plus budesonide group, but therapy with terbutaline and budesonide alone also was associated with significant improvement in PaO2 and CL, as compared with placebo.

    Conclusions. Treatment of acute chlorine gas lung injury with aerosolized terbutaline followed by aerosolized budesonide improved lung function. Combined treatment was more effective than treatment with either drug alone.

  • 8. Willebrand, Mimmie
    et al.
    Andersson, Gerhard
    Linköpings universitet, Filosofiska fakulteten. Linköpings universitet, Institutionen för beteendevetenskap, Avdelningen för klinisk och socialpsykologi, CS.
    Ekselius, Lisa
    Prediction of psychological health after accidental burn2004Inngår i: Journal of Trauma, ISSN 0022-5282, E-ISSN 1529-8809, Vol. 57, s. 367--374Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background: Burn victims often display psychological symptoms that can impede recovery, but knowledge about risk factors for psychopathology is limited. The aim was to predict psychological health at three months post-burn from coping and trauma-related factors assessed early in hospitalization. Methods: Thirty-four burn patients were interviewed during hospitalization about the accident and coping. Questionnaires were administered during hospitalization and at three months post-burn, including the Impact of Event Scale-Revised for posttraumatic stress symptoms (intrusion, avoidance, arousal) and the Hospital Anxiety and Depression Scale for mood. Results: Anxiety, depressive and avoidant symptoms at three months were highly predicted by baseline levels of these symptoms, and avoidant coping. Life threat when being burned predicted intrusive and arousal symptoms, and coping by Self-control predicted less intrusive symptoms. Burn severity was not predictive of psychological health. Conclusions: Coping style, life threat during the accident and early symptomatology are strong predictors of post-burn psychopathology.

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