Biomedical subjects

A Kopf

Publications and source records attributed to A Kopf.

At least 55 records · Page 3Linked to original sources

PubMed1995

The necessity of selenium substitution in total parenteral nutrition and artificial alimentation.

For the trace element selenium, in contrast to zinc, iron, copper, chromium, manganese and iodine, there is still no clear official recommendation with regard to routine substitution in artificial nutrition. An overview of the manifestations of selenium deficiency in humans during the period 1979-1995 shows that nutritive deficiencies are exclusively TPN-induced or the result of severe malnutrition. The pathology of TPN-induced selenium deficiency and the analytic assessment of selenium status are described. Patients undergoing long-term parenteral nutrition or suffering from an increased loss of intestinal secretions have to be characterized as being especially at risk for clinical selenium deficiency. The relationship of the serum selenium kinetics in pediatric and adult patients to the depletion of body compartments during the course of short-term and prolonged TPN is discussed. Because of the importance of the selenoproteins, the regularly occurring depletion during selenium-free TPN and the borderline supply of selenium in Germany the routine substitution of selenium in TPN is strongly recommended. The pharmaceutical industry should be encouraged to develop a trace element solution that includes selenium, so that the nutritive requirement of patients on TPN can be satisfied. Adequate intravenous dosage recommendations are based on maintenance of glutathione peroxidase homeostasis. The routine supplementation dosage may not meet the selenium requirements of intensive care patients under conditions of increased metabolic demands on their anti-oxidative system.

Enteral Nutrition↗

PubMed1994

Parenteral aluminum loading in critical care medicine. Part II: Response to aluminum load from long-term parenteral nutrition.

OBJECTIVE: Evaluation of the iatrogenic aluminum load by aluminum-contaminated nutritive infusion solutions in long-term total parenteral nutrition (TPN). PATIENTS: 16 consecutive patients (6 children, 10 adults) who had to undergo total parenteral nutrition for more than one month. Three of them were from a home parenteral nutrition program. The duration of TPN was up to 68 months. The parenteral aluminum load was calculated on the basis of the individual TPN programs. Six patients were exposed to an additional parenteral aluminum load in the course of intensive care. Comparative group: To establish a reference range, the serum aluminum concentrations were determined in 71 unloaded patients who had to undergo minor surgical procedures. ALUMINUM ANALYSIS: Strict adherence to a contamination-free sampling and processing technique. The aluminum determination was performed at the Hahn-Meitner-Institute Berlin by means of graphite-furnace atomic absorption spectrometry (GFAAS). RESULTS: The TPN-associated daily aluminum load was 3.5 +/- 0.4 micrograms/kg body weight (bw) in children and 2.2 +/- 1.8 micrograms/kg bw in adults. 59 +/- 6% of the intravenous aluminum load in children and 42 +/- 16% in adults was due to the highly contaminated small-volume calcium, inorganic phosphate, trace element and vitamin parenterals. The median serum aluminum concentration under TPN was 10.9 micrograms/l (range: 5.0-26.9 micrograms/l) and was thus 7.3 times higher than in the preoperative control group (median: 1.5 micrograms/l, 95% confidence interval: < 0.6-3.5 micrograms/l). Individual values ranged up to 36.8 micrograms/l. CONCLUSIONS: The aluminum intake of patients on parenteral nutrition in Germany is thus on occasion considerably above the ASCN/ASPEN recommendations for the limitation of intravenous aluminum loading (ASCN: American Society for Clinical Nutrition; ASPEN: American Society for Parenteral and Enteral Nutrition). The toxicological significance of parenteral aluminum loading is discussed. The results suggest that limits should be established for the Aluminum contamination of infusion solutions.

Adult↗

PubMed1987

Prognostic significance of hypopigmentation in malignant melanoma.

It has been suggested that the presence of cutaneous hypopigmentation favorably influences the prognosis of patients with malignant melanoma (MM). To examine this possibility, we have compared the actual with the predicted survival of 46 patients with MM and hypopigmentation who were among 1130 patients with MM entered in a long-term prospective study of MM at the New York University Medical Center. The actual average five-year survival rate of the patients with MM and hypopigmentation (86.3%) was significantly better than predicted (74.8%) on the basis of the risk factors present in each patient at the time of entry into the study. The findings suggest that hypopigmentation is a factor that beneficially influences the prognosis of MM, and that the mechanisms that inhibit or destroy normal melanocytes in patients with MM may also slow the growth of this cancer.

Humans↗

PubMed1987

[Obstruction of the upper excretory tract associated with primary urinary infection. Diagnosis, treatment and course. Apropos of 196 cases].

The association of upper urinary tract obstruction and urinary tract infection is a relatively common disease which requires early diagnosis and systematic treatment. The diagnosis of this disease can be difficult as many patients present with totally asymptomatic forms which may be revealed suddenly and totally unpredictably by an episode of severe infection. 196 (16%) of the 1,225 patients operated between January 1977 and June 1985 for upper urinary tract obstruction also presented with urinary tract infection at the time of admission. Suggestive urological signs were present in only 49% of the patients and infectious signs were present in 39%. 26 patients had acute renal failure and 9 presented at least 3 signs of severity. The bacteria most frequently isolated were E. coli (29% of M.S.U.s and 11% of blood cultures) and Proteus mirabilis (30% of M.S.U.s and 11% of blood cultures). Treatment always consisted of a combination of surgery and antibiotic therapy. Surgery was conservative in only 71% of patients at the first operation. 23 patients required specific symptomatic treatment due to the presence of signs of severity. Renal function, evaluated on the basis of the serum creatinine, was considerably improved by treatment, particularly in patients with acute renal failure on admission. In terms of bacteriological results, 92% of patients were discharged from hospital with sterile urine. 20% of the patients reviewed as outpatients had persistent urinary tract infection, generally caused by Proteus mirabilis. Three patients (1.5%) died, including 2 from the initial infectious syndrome.

Acute Kidney Injury↗

PubMed1984

[Single-dose preventive treatment of urinary tract infections after endoscopic resection of the prostate].

The ability of mezlocillin to prevent urinary tract infection after trans-urethral prostatectomy was evaluated in a randomized trial involving 100 patients (49 treated and 51 controls) with bacteria-free urine prior to surgery. One single 2 g dose of the antibiotic was administered intravenously 1 hour before the operation. Mezlocillin was chosen on the results of a preliminary study of post-trans-urethral prostatectomy urinary tract infections in 150 patients and was given as a single dose to prevent the development of multiresistant strains. Both groups of patients were comparable with regard to age, percentage of malignant tumours, weight of resected tissue and duration of post-operative bladder catheterization. Following surgery, bacteriuria (greater than or equal to 10(5) organisms/ml) was present in 18.4% of treated patients and in 51% of controls (p less than 0.001), the difference being significant on the 2nd and 5th post-operative days (p less than 0.01 and p less than 0.05 respectively). Clinical signs of infection were less frequent, and the duration of post-operative stay in hospital was reduced by more than 1 day in the treated group.

Clinical Trials as Topic↗

PubMed1984

[Eosinophilic cystitis of allergic origin].

Eosinophilic cystitis, of which 35 cases have been published, is a recurrent cystitis remarkable for its chronicity and for the importance of haematuria; the urine is usually sterile and blood eosinophilia frequently present; at histology, infiltration of the vesical wall by eosinophils is pathognomonic. In view of the irregular results of cortico-steroid treatment, a search for causative factors is required. Parasitic infestation has been suspected but never actually proven, and an allergic origin probably is frequently missed. We report two cases of eosinophilic cystitis where allergy to penicillin and clometacin respectively could be demonstrated for the first time and in which the condition subsided after withdrawal of these drugs.

Analgesics↗

PubMed1984

[Does the ferritin level have a practical value in chronically hemodialized patients?].

In order to determine whether serum ferritin assay has any advantages compared with usual hematologic parameters, serum ferritin was assessed in 70 hemodialysed patients. It was positively correlated with the number of blood units infused, but there was no correlation with iron treatment, serum iron or the degree of anemia. However, the interpretation of the results is difficult, because of the large dispersion of serum ferritin levels. Therefore, the determination of serum ferritin concentration cannot be recommended as a current method to follow-up and manage anemic chronic hemodialysed patients, especially when the cost of the test is taken into account.

Female↗

PubMed1984

Prognosis in Stage 1 malignant melanoma: seven-year follow-up study of splenic radiocolloid uptake as predictor of death.

In an earlier study we found that patients with clinical Stage 1 and 2 cutaneous malignant melanoma and increased splenic radiocolloid uptake had more frequent recurrence at 24 mo, compared with melanoma patients having normal liver-spleen scintigrams. This report, an 80-mo follow-up study, gives further information on 119 clinical Stage 1 patients. Fifteen of 35 patients with increased splenic uptake (42.9%) died from melanoma as opposed to only 16 of 84 (19.1%) with normal liver-spleen images (p less than 0.01). Multivariate analysis showed that augmented splenic uptake of technetium-99m sulfur colloid is a marker for adverse prognosis in patients with malignant melanoma but does not appear to be an independent variable in predicting death. In clinical Stage 1 patients, increased splenic uptake correlated significantly with pathologic stage (positive elective node biopsy) as well as thickness and mitotic rate in patients with thicker lesions. It may be that patients with thicker, pathologically aggressive tumors have an increased splenic blood flow and/or enhanced immune and reticuloendothelial response (as manifested by abnormal liver-spleen scintigram). If so, the enhanced immune response does not appear to contribute to overall survival.

Adult↗

PubMed1982

Determination of half-dose depth in skin for soft x-rays.

Unlike superficial x-rays, the soft x-rays normally used in dermatologic practice spare unaffected underlying organs during treatment of cutaneous malignancies. However, since the dose with depth from soft x-rays varies markedly, it is important to know this relationship for optimal therapeutic results. The peak kilovoltage, and thus the energy of the beam, is generally selected so that the dose to the base of the lesion is one-half the surface dose. An absorbed dose of 3,400 rads to the surface and a dose of about one-half this amount to the base of most malignant lesions is one standard protocol for optimal therapeutic results. An accurate value of half-depth dose in skin is therefore necessary and is readily obtained from ordinary half-value layer measurements using the technic described.

Aluminum↗

PubMed1980

[Thrombo-embolism in urologic surgery. Prevention by heparin of antiprothrombic drugs. A retrospective report of 2,657 cases (author's transl)].

Three groups of patients undergoing urological operations were given a prophylactic regimen of either subcutaneous heparin (n = 1143), antiprothrombics (n = 944) or no medication (n = 570). Results were deemed through simple clinical criteria. They were similar for the whole of patients and for some types of surgery, pecularly protatic: Anticoagulation induced a significant lowering of the frequency of thromboembolism, heparin being more efficient than antiprothrombics. It does not increase the percentage of haemorrhages. More, peridural anesthesia is not contre-indicated by heparin. However, parietal problems appear to be more frequent among heparinized patients.

Adolescent↗

PubMed1976

[Indications for arteriography and determination of parathyroid hormone in staged venous samplings in primary hyperparathyroidism].

The information provided by parathyroid arterigraphy and staged venous sampling with parathormone estimation is essentially related to localisation and is of little diagnostic value. It is not justifiable on a routine basis before all operations. These techniques are particularly useful in patients with practically definite hyperparathyroidism and who have already undergone a negative exploratory operation or surgery with insufficient excision.

Angiography↗

PubMed1973