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Biomedical subjects

G Kleinberger

Publications and source records attributed to G Kleinberger.

At least 55 records · Page 3Linked to original sources
PubMed1984

Substance P is markedly increased in plasma of patients with hepatic coma.

Substance P (determined as immunoreactive substance P [i-SP]), noradrenaline, and adrenaline were measured in plasma of 18 patients with hepatic coma (stage I-IV), 16 healthy controls, and 10 critically ill patients without evidence of hepatocellular disease. Plasma i-SP (119 +/- 13 fmol/ml) was significantly higher in patients with hepatic coma than in healthy controls (13 +/- 2 fmol/ml) or control patients (23 +/- 4 fmol/ml). Plasma i-SP rose in parallel with plasma noradrenaline and adrenaline. There was a significant direct correlation between plasma i-SP and noradrenaline. Increase in plasma i-SP and noradrenaline was associated with a decrease in systemic vascular resistance and an increase in cardiac index and was most pronounced in those patients who finally died in coma. Deterioration in the dying patients was accompanied by a further significant increase in plasma i-SP. Immunoreactivity was identified as authentic SP by high performance liquid chromatography in 3 representative patients. Accumulation of the vasodilating peptide SP in plasma of patients with hepatic coma may be important in the pathogenesis of the cardiovascular disturbances associated with this disease.

Adolescent↗
PubMed1984

Bedside estimation of extravascular lung water in critically ill patients: comparison of the chest radiograph and the thermal dye technique.

Extravascular lung water (EVLW) was estimated in 53 critically ill patients by the chest radiograph (CXR) and the thermal dye technique. The comparison between these two methods revealed a direct and positive correlation (r = 0.83, p less than 0.001). However, EVLW-values obtained by the thermal dye technique showed considerable overlap between cases of radiographic low grade pulmonary edema and we were able to identify several reasons for radiographic over- or underestimation of EVLW. In these patients EVLW-measurement by the thermal dye technique provides additional information, thereby probably influencing further treatment.

Adult↗
PubMed1984

Lung perforation by nasogastric feeding tubes.

Endotracheal misdirection of narrow bore nasogastric feeding tubes resulted in perforation of the lung, pneumothorax and hydrothorax in two intensive care patients. Both were intubated with cuffed endotracheal low pressure tubes, one patient was on respirator therapy with neuromuscular relaxation. Feeding tubes were inserted by experienced personnel with the assistance of a steel stylet without difficulties. Aspiration of fluid was misinterpreted as proof of correct positioning, the liquid being however pleural effusion and not gastric juice. Similarly auscultation of gurgling sounds in the upper epigastrium was not a reliable sign of intragastric position. Insertion of nasoenteric feeding tubes may be complicated by perforation of the upper gastrointestinal tract and lung in poorly responsive patients with cuffed endotracheal devices during neuromuscular blockage. In these patients a laryngoscope and forceps should be used to ensure free passage of the tube into the oesophagus. Röntgenographic confirmation of correct positioning of the tube immediately after insertion is mandatory.

Journal Article↗
PubMed1984

[Partial parenteral nutrition in severe virus hepatitis].

Patients with severe virus hepatitis and a prothrombin concentration below 25% have a bad prognosis. This is due to direct consequences of hepatic failure and to the rather frequent complications of this disease. The clinical course of such patients is essentially dependent upon the degree of liver regeneration, which again is dependent upon the mass of hepatocytes which are able to regenerate and upon the so called hepatotrophic factors. Patients with severe hepatitis suffer during the first weeks rather frequently from nausea and loss of appetite and for that reason their nutrition is insufficient. In the study recorded here 9 cases were investigated (7 patients with hepatitis B, 2 patients with hepatitis non A non B). The question was asked, if partial parenteral nutrition in addition to a liver diet not containing meat would improve liver function. It could be shown that the prothrombin concentration, which could not be improved by vitamine K1 supplements, was increased during a 7 day parenteral nutrition period from 19,3 +/- 2,9% to 41,5 +/- 8,1% (p less than 0,05), serum albumine and cholinesterase activity improved as well. During the first day of treatment there was a significant fall of ammoniac from 115 +/- 10 mumol to 73 +/- 10 mumol/l (p less than 0,05), at the same time production of urea did not increase. All patients survived. The results show, that parenteral nutrition can improve liver function and decrease the catabolic status of metabolism.

Adolescent↗
PubMed1984

[Diagnosis and effective therapy with plasmapheresis in a patient with homozygous familial hypercholesterolemia].

The case of a 17-year-old boy with the homozygous form of familial hypercholesterolaemia is reported. The patient presented tuberous and tendinous xanthomas, arcus lipoides, complete occlusion of the LAD of the coronary arteries, a characteristic family history, and total cholesterol levels greater than 600 mg/dl. Among the available therapeutic regimens we decided to perform plasma exchange treatment, which was introduced by Thompson in 1973 as therapy of this metabolic disorder. After each plasmapheresis, performed so far 7 times, the cholesterol and LDL-cholesterol concentrations dropped to normal levels; they increased again within the next 3 weeks, without, however, reaching the pretreatment levels. Undergoing this treatment, the xanthomas decreased markedly; there are reasons to assume that atherosclerotic lesions might also decrease during this treatment.

Adolescent↗
PubMed1983

Serum levels of gamma-aminobutyric-acid-like activity in acute and chronic hepatocellular disease.

Serum levels of GABA (gamma-aminobutyric acid)-like activity were measured by a radioreceptor assay in 22 healthy subjects and 170 patients with liver diseases. Levels were within normal limits (mean +/- SEM in healthy controls 0.52 +/- 0.04 mumol/l; range 0.2-0.8 mumol/l GABA equivalents) in most patients with uncomplicated acute viral hepatitis, compensated chronic hepatitis, and primary biliary cirrhosis (PBC). In 96% of patients with compensated (non-PBC) cirrhosis levels were slightly high (1.5 +/- 0.06 mumol/l). In 4 patients with decompensated cirrhosis but without hepatic encephalopathy (range 3.0-6.4 mumol/l) and in most of 26 patients with overt hepatic encephalopathy due to acute or chronic hepatocellular failure (range 2.3-18.0 mumol/l) levels were very high. Levels did not correlate closely with the clinical stage of hepatic encephalopathy or with arterial plasma ammonia concentrations. particularly high levels were detected in patients with cirrhosis 12-16 h after gastrointestinal haemorrhages. These findings are compatible with the hypothesis that the GABA neurotransmitter system is involved in the pathogenesis of hepatic encephalopathy in man.

Adult↗
PubMed1983

Effect of gut lavage on phenobarbital elimination in rats.

In the management of intoxications, the major goals are enhanced elimination of the toxin from the organism and prevention of further absorption. Absorption of an orally administered substance from the gastrointestinal tract can be decreased by adequate washing of the stomach. Delayed absorption of the substance from the small intestine cannot be avoided by this procedure and after the gastric lavage, a nonspecific absorbent must be administered and diarrhea induced (1). This study demonstrates that iatrogenic diarrhea via gut lavage can also eliminate toxins already absorbed by the body.

Animals↗
PubMed1983

[General characteristics and problems of the galenic aspects of fat emulsions].

The development of a clinically applicable intravenous fat emulsion has a long history. The gain of knowledge about the best lipid and emulsifying system had an intermittent development and led to three generations of distinct fat emulsions. For the evaluation of a fat emulsion it is necessary to compare the results of the same generation only. In the past, many misinterpretations came from mixing the results of different generations. It can be stated that by considering the contraindications, application schedules and basal galenic aspects, only minimal side effects from a parenteral administration of fat emulsions can be seen. Today the most important aspects of parenteral nutrition with fat emulsions are the galenic ones, which are often overlooked. The staining of the liposomes of the fat emulsions with 2% OSO4 make electron microscopic investigations of the liposomes possible after mixing them with carbohydrates, amino acids, electrolytes, vitamins and trace elements. The liposomes of soybean oil emulsions in different "All In One" (AIO) solutions have been under current investigations. The results demonstrated that the liposomes of fresh AIO-solutions carry highly osmiophilic inclusion bodies. Prolonged storage led to further alterations, as change of shape, loss of osmiophility and finally formation of liposomes ghosts. In solutions kept at 4 degrees C those changes developed between the 1st and 2nd month of storage, whereas storage at 22 degrees C was harmless within 48 h only. Therefore, it is recommended that already prepared AIO solutions are kept at 4 degrees C and used as soon as possible.

Carbohydrates↗
PubMed1983

General properties of 14C-L-Valine-binding to human brain tissue.

L-Valine (VAL) binding is saturable, reversible, linear within a protein concentration of 0.2 to 0.8 mg prot./ml, pH dependent (pH-optimum 7.1 to 7.4), temperature dependent with extremely low binding at 0-4 degrees C; the assay runs at 37 degrees C; it is ion dependent (Bmax:CaCl2 (5mM): + 100%; NaCl (5 mM): -50%); very sensitive to TRITON X-100 (Bmax at 0.01%; -70%); N-ethylmaleimide (0.5 mM): Competitive inhibition; no change in non-specific binding; there are no effects by puromycin plus GTP; VAL binds to synaptic membranes of human frontal cortex with KD-values several fold lower than that observed with homogenates, the distribution of VAL-binding is different in various human brain areas and can be inhibited by L-leucine, L-isoleucine, L-serine, DL-threonine, glycine and D-valine, while aromatic amino acids, beta-alanine, GABA, taurine, glutamate, proline and gamma-glutamyltaurine have no effects of 10(-3) M.

Aged↗
PubMed1983

Lipid metabolism in acute renal failure.

Plasma lipid and lipoprotein composition was investigated in acute renal failure (ARF). Forty-seven percent of the patients showed hypertriglyceridemia, whereas serum cholesterol was slightly reduced. Triglyceride (TG) content, predominantly of LDL and to a lesser degree of VLDL, was elevated. Cholesterol concentrations of HDL and LDL fractions were markedly reduced. HDL-TG and VLDL-cholesterol were in the normal range. Forty percent of the patients had a type IV hyperlipoproteinemia. Post-heparin lipolytic activity (PHLA) was reduced owing to an inhibition of hepatic-TG-lipase (HTGL) activity, whereas protamine-inactivated LPL was in the normal range. Fractional elimination (K2) of parenterally administered fat emulsions, determined by an intravenous fat tolerance test (IVFTT) was reduced to 2.44% min, about half of normal. The fat elimination rate increased but did not normalize during parenteral nutrition with amino acids and glucose, suggesting enhanced lipid deposition. Alterations of lipid metabolism develop early in ARF (by 4 days) and, in general, are not influenced by residual renal function, urinary output, or duration of renal failure.

Acute Kidney Injury↗
PubMed1983

[Non-cardiogenic pulmonary edema].

Non-cardiac pulmonary edema comprises all types of pulmonary edema not caused by increase of left ventricular filling pressure and elevated pulmonary capillary pressure. In one year 42 patients at our intensive care unit developed non-cardiac pulmonary edema. In a retrospective study the clinical, radiological and functional changes in patients with non-cardiac pulmonary edema were determined. 76% of the patients had multiple causes for development of non-cardiac pulmonary edema. Sepsis was the most frequent predisposing disease. Over-all mortality reached up to 69%. Additional organ failure caused an increase in mortality. Patients without complications had the best prognosis. Mechanical ventilation (69%), high-dose corticosteroids (50%), hemodialysis with ultrafiltration (33.3%) and hemofiltration (7.1%) were used for treatment of non-cardiac pulmonary edema.

Acute Disease↗
PubMed1982

[Diagnostic key for intensive care patients: combination of clinical parameters with laboratory findings].

A new diagnostic key has been established based on the reports of 3845 critically ill patients in our medical intensive care unit. The clinical diagnoses in these patients were classified in 22 different groups according to different organs or etiological entities (diseases of the liver, infectious diseases, intoxications etc.). 42 different laboratory parameters were selected for classification of metabolic or organ-related complications. Combining of clinical diagnoses with laboratory values characterizes the seriously ill patient. Our new system proved to be practicable in describing the degree, complications and prognosis of disorders in intensive care medicine. The results are demonstrated in patients with hepatic coma.

Clinical Laboratory Techniques↗
PubMed1982

Fat elimination in acute renal failure.

Lipid metabolism and elimination of parenterally administered fat were investigated in 15 patients with acute renal failure (ARF). The mean triglyceride level was elevated to 2.56 +/- 1.43 mmol/l and the mean cholesterol level was 3.32 +/- 0.66 mmol/l, which is slightly below the normal range. A type IV hyperlipoproteinaemia was present in 47 per cent of the patients. The triglyceride content of LDL and VLDL was elevated and the cholesterol concentration of HDL and of LDL was reduced markedly. The fractional removal rate of triglycerides (K2) evaluated by an intravenous fat tolerance test using a bolus technique was reduced to 2.44 +/- 1.56 per cent/min which is about half of normal and correspondingly the elimination half life was prolonged to 28.4 min. No correlation could be demonstrated between the impairment of fat elimination and residual renal function, basal and VLDL triglyceride concentration or HDL cholesterol content.

Journal Article↗
PubMed1982

Systemic candidiasis complicating bone marrow transplantation in aplastic anemia. Case report.

A 17-year-old male patient with aplastic anemia underwent bone marrow transplantation and succumbed 4 days after marrow infusion from sudden myocardial failure. Fever of unknown origin (FUO) had accompanied the patients course from admission until death. The cause of death was fungus myocarditis, which had escaped detection in vivo, in spite of a daily culture program for bacteria and fungi, and a close monitoring of the patients circulation and ventricular performance. Commonly applied diagnostic criteria for systemic mycosis, such as topical colonization, malfunction of invaded organs and positive fungus cultures failed to provide a timely diagnosis. With regard to the problems in diagnosing systemic mycosis, the potential stem cell toxicity of antifungal drugs and the need for immunosuppressive therapy prior to marrow infusion, we strongly recommend not to start the transplantation procedure unless FUO has been treated successfully.

Adolescent↗
PubMed1982

Morphologic changes of Intralipid 20% liposomes in all-in-one solutions during prolonged storage.

Liposomes of Intralipid 20% in four solutions already mixed for total parenteral nutrition (TPN) were studied by means of a transmission electron microscope. Samples of those so-called all-in-one solutions containing all components for TPN in one bottle were taken immediately after the mixing procedure was finished, then after 24 h, 48 h, 1 week, 2 weeks, 1 month and then monthly up to 6 months afterwards. Storage was carried out for one half at 4 degrees C, for the other at 22 degrees C in darkness. The study showed that liposomes of Intralipid 20% in fresh TPN solutions decreased in their medium diameter from 0.8 to 0.6 micrometers. They carried highly osmiophilic inclusion bodies. Prolonged storage led to further alterations, as change of shape, loss of osmiophility, and lastly formation of liposome ghosts. In solutions kept at 4 degrees C those changes developed between the 1st and 2nd month of storage, whereas storage at 22 degrees C was harmful within 48 h. It is recommended, that already prepared TPN solutions should be kept at 3 degrees C and used as soon as possible, until further studies provide exact guidelines for storage time.

Drug Storage↗