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A Kari

Publications and source records attributed to A Kari.

80 records · Page 5Linked to original sources
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Integration of knowledge-based system and database for identification of disturbances in fluid and electrolyte balance.

We describe a knowledge-based system which automatically identifies fluid and electrolyte disorders in intensive care patients. The knowledge-based system was built and interfaced to an existing patient data management system (PDMS) in Kuopio University Central Hospital to evaluate the potential of knowledge-based techniques in information management and decision support in the high dependency environment. Because of the integration, the system does not require any manual data input, and it provides a natural extension and increased performance to a current patient data management system used in clinical practise. The paper discusses design considerations and gives the system description. The evaluation of the experimental system in clinical use showed that it performed almost as well as junior clinicians of the intensive care unit.

Artificial Intelligence↗
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Polyamine excretion in depleted patients with gastrointestinal malignancy: effect of perioperative nutrition and tumor removal.

Polyamines, synthesized by all mammalian cells, are involved in protein and energy metabolism. We measured urinary excretion of polyamines, putrescine, spermidine, spermine, and their metabolites N1-acetylspermidine and N8-acetylspermidine, resting energy expenditure, and nitrogen excretion in 12 depleted patients with gastrointestinal malignancy during preoperative and postoperative parenteral nutrition and in 7 patients with multiple trauma receiving similar parenteral nutrition. During preoperative nutrition support, the excretion of putrescine (p less than .05) and total polyamines (p less than .01) increased by 420% and 60%, respectively. Increases in energy balance and resting energy expenditure during nutrition could entirely explain the observed changes in polyamine excretion. Preoperatively, the excretion of N1-acetylspermidine (p less than .05), N8-acetylspermidine (p less than .001) and total polyamines (p less than .05) was higher in patients with a surgically noncurable tumor than in those with a surgically curable tumor. The energy balance and resting energy expenditure could also explain the differences in polyamine excretion between patients with surgically curable and noncurable disease, excluding the increased N8-acetylspermidine. Postoperatively, the excretion of N8-acetylspermidine in patients with multiple trauma without malignancy and in patients with palliative operation was similar, and was higher than in patients with a totally resected malignancy (p less than .01). Our results suggest that the excretion of polyamines reflects the activity of energy metabolism in general and that polyamine excretion is not specific for any particular disease.

Adult↗
PubMedDate not supplied

Branched-chain and mixed amino acid solutions and thermogenesis in postoperative patients.

The effect of amino acid composition on the thermogenic response to amino acid infusion was studied in 20 spontaneously breathing postoperative coronary bypass patients and 6 healthy volunteers. On the 1st postoperative day, patients received either a balanced amino acid solution (2510 kJ/24 h) or an amino acid solution consisting primarily (88.8%) of branched-chain amino acids (BCAAs; 2510 kJ/24 h) for 6 h. Another group of patients receiving only hypocaloric glucose served as control subjects. The volunteers randomly received the same balanced amino acid solution (2510 kJ/24 h) or the same BCAA-enriched solution (2510 kJ/24 h) for 6 h. In the coronary bypass patients, both infusion regimens resulted in an increase in resting energy expenditure (REE) (p < 0.01). The thermogenic response to nutrition was 28.5 +/- 5.8 and 46.9 +/- 4.3% (mean +/- SE) in the patients receiving the balanced and BCAA-enriched solutions, respectively (p < 0.05). REE did not change in the control group. Alveolar ventilation increased in both groups (p < 0.05), and the change was more prominent in patients receiving the BCAA-enriched solution. PaCO2 decreased significantly in both nutrition groups. In the healthy subjects, REE increased only during the balanced amino acid infusion (p < 0.05). The thermogenic response to the balanced amino acid solution was 20.7 +/- 4.2% (p < 0.05), whereas no thermogenic response to the BCAA-enriched solution was observed (-5.6 +/- 3.3%, NS). This difference was probably due to the smaller energy cost of BCAA metabolism.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Differential effects of sepsis and trauma on urinary excretion of polyamines.

Urinary excretion of polyamines increases in patients with trauma and infection. To separate the effect of infection from the general metabolic response to sepsis, we studied 7 patients with sepsis and 13 patients with multiple trauma in the intensive-care unit. Urinary excretion of total and free polyamines, putrescine, spermidine, spermine, and their metabolites N1-acetylspermidine (N1-AcSPD) and N8-acetylspermidine (N8-AcSPD), and energy and nitrogen balance were measured. The patients were randomized to receive either hypocaloric glucose alone or with amino acids for 2 days. The excretion of individual polyamines, except spermine, significantly exceeded normal values in both patient groups; the excretion of total polyamines was 530 and 323% higher than normal in patients with sepsis and trauma, respectively. The excretion of N1-AcSPD and total spermidine was 141 and 74% higher in patients with sepsis than in patients with trauma, respectively (p < 0.05), whereas the excretion of N8-AcSPD was equal in both patient groups. This was also reflected as a significantly increased urinary ratio of N1-AcSPD to N8-AcSPD in septic patients (6.37 +/- 1.61; mean +/- SE) compared with patients after injury (2.69 +/- 0.27, p < 0.01) or a healthy population (1.08 +/- 0.04, p < 0.001). Amino acid infusion had no effect on polyamine excretion. The mean energy balance was -17.0 +/- 1.1 and -19.1 +/- 1.1 kcal.kg-1.day-1, and the mean nitrogen balance was -0.17 +/- 0.03 and -0.15 +/- 0.02 g.kg-1.day-1 in patients with sepsis and trauma, respectively (NS).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMedDate not supplied

Nutrition status, severity of illness, and thermogenic response to parenteral nutrition.

The effect of the degree of metabolic stress on the thermogenic response to parenteral nutrition was studied in surgical and intensive-care patients. Indirect calorimetry was measured before and 3 h after the start of parenteral nutrition. The following patient groups were studied: depleted ward patients before and after surgery for gastrointestinal malignancy (n = 16), mechanically ventilated sepsis/injury patients (n = 21), and spontaneously breathing intensive-care sepsis/injury patients (n = 8). The patients received either nonprotein energy alone (glucose/fat 30/70%) at a rate corresponding to 1.4-1.6x baseline resting energy expenditure (REE) or amino acids (1.5 g.kg-1.day-1) and hypocaloric glucose. There was no correlation between the thermogenic effect of nutrition and the degree of hypermetabolism or degree of malnutrition. There was no significant thermogenic response to either amino acids or hypercaloric lipids and glucose preoperatively. In the depleted patients, REE increased because of the operation (p < 0.05); postoperatively, only amino acids increased REE significantly (p < 0.05). The operation enhanced the thermogenic response, which was higher to amino acids than to nonprotein energy (27.2 +/- 9 vs. 5.3 +/- 2.2%, means +/- SE, p < 0.05). In the sepsis/trauma patients, REE increased in both nutrition groups (p < 0.05). The thermogenic response (19.7 +/- 6.5 and 8.0 +/- 3.2% in patients receiving amino acids and nonprotein energy, respectively) was similar to that of the depleted patients postoperatively and was similar in sepsis and trauma patients. We conclude that the thermogenic response to parenteral amino acids and nonprotein energy is minor in depleted patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMedDate not supplied

Patterns of energy expenditure in intensive-care patients.

We studied the changes in energy expenditure (EE) in response to multiple injury (n = 6), subarachnoidal hemorrhage (n = 8), low-cardiac-output syndrome after open-heart surgery (n = 6), and uncomplicated coronary artery surgery (n = 10). Measurements were made during 5 consecutive days. In the multiple injury group, EE was 30% higher than predicted basal EE (range 10-52%) within 27 h after trauma, and this hypermetabolism remained unchanged throughout the study. After subarachnoidal hemorrhage, EE was 18% higher than predicted (range 0-45%) and the operation caused only a minor further increment in EE. Also, these patients remained hypermetabolic throughout the study. In the low-cardiac-output syndrome group, the increase in EE was less prominent (mean 15%, range 0-34%), but the pattern of hypermetabolism was similar to that observed in the multiple injury and subarachnoidal hemorrhage groups. The metabolic response to uncomplicated coronary artery surgery resembled the response to general surgery. We conclude that 1) there is an early consistent increase in EE in various groups of surgical intensive-care patients; 2) with appropriate treatment of the circulation, a prompt hypermetabolic response to surgical trauma is maintained even during low-cardiac-output syndrome; and 3) the marked hypermetabolism after subarachnoidal hemorrhage at the central nervous system is an integral part of the hypermetabolic response to injury.

Adult↗