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Biomedical subjects

G Zobel

Publications and source records attributed to G Zobel.

At least 91 records · Page 5Linked to original sources
PubMed1989

[N-acetyl-beta-D-glucosaminidase (NAG) in the urine. An additional parameter for diagnosing the site of urinary tract infection].

Urinary excretion of NAG was determined in 32 patients aged four months to 15 years with urinary tract infection (UTI). Level diagnosis was made by means of commonly accepted clinical and laboratory criteria. Pathological enzymuria was present in all 15 patients with pyelonephritis while 12 of 14 children with cystitis had a normal urinary NAG excretion. Two patients with cystitis and 3 patients with questionable level diagnosis had elevated urinary NAG levels. According to these data the level diagnosis of UTI was changed in 16% of the patients by including the NAG values. Follow-up studies of nine patients showed a significant decrease of initially elevated urinary NAG levels after a 10-days course of antibiotic treatment and the values were within the normal range in 8 of 9 patients. Determination of urinary NAG excretion seems to be of definite value as an additional parameter for level diagnosis of childhood urinary tract infection.

Acetylglucosaminidase↗
PubMed1989

[Respiratory insufficiency in acute bronchiolitis in infancy].

Forty-one infants with acute viral bronchiolitis were hospitalized in our paediatric intensive care unit during the seven year period from 1980 to 1987. In 14 out of 27 evaluated patients, Respiratory Syncitial Virus (RSV) was detected in the nasal secretions. Twenty-three children required only supportive care and monitoring. Eighteen infants had to be ventilated because of respiratory failure. The major indication for mechanical ventilation was an arterial or capillary pCO2 of more than 64 mmHg; other criteria were repeated apnoea, respiratory acidosis, and clinical deterioration. In all cases the type of the mechanical ventilation was an intermittent mandatory ventilation (IMV) with flow and time cycled respirators; muscle relaxation was not required in any case. The average duration of mechanical ventilation was 40 hours. All the children recovered uneventfully. These data suggest that even the most severe cases of acute bronchiolotis can be treated successfully, and that the mortality rate of this disease entity can be reduced to zero.

Bronchiolitis, Viral↗
PubMed1988

[Tasks and organization of a pediatric intensive care unit].

Paediatric intensive care medicine mainly involves infants during the neonatal period and, in particular, premature babies. 70% of the children on assisted ventilation at the paediatric hospital of Graz University in 1985 and 1986 were neonates. Older children needing mechanical ventilation comprised only 1.6% of the total number of patients at our paediatric hospital. Paediatric intensive care units are therefore almost exclusively neonatal care units. Otherwise when serving the needs of children beyond the neonatal period these units are mostly required by paediatric subspecialities (i.e. cardiology, burns unit etc.). In view of the small number of patients in this group a high-standard paediatric intensive care unit should be multidisciplinary and preferentially attached to a university hospital rather than a regional hospital so as to maximise experience in the management of these children and ensure optimal care.

Austria↗
PubMed1988

Vascular access for continuous arteriovenous hemofiltration in infants and young children.

The blood flow through the hemofilter device is the key point for ultrafiltrate production during continuous arteriovenous hemofiltration. It mainly depends on arteriovenous pressure gradient and vascular access, which is the major problem for arteriovenous hemofiltration in infants and small children. In infants, we inserted short 18-20 gauge catheters into the radial or brachial artery and the internal jugular vein and achieved mean blood flow and ultrafiltration rates of 6.5 +/- 2.2 and 1.3 +/- 0.3 ml/min, respectively. In small children, we placed 4 or 5 French catheters into the femoral vessels, and achieved mean blood flow and ultrafiltration rates ranging from 18.5 to 63.6 and 1.9 to 6.9 ml/min, respectively. The only catheter-related complication was a femoral artery thrombosis, which needed surgical revision. These results show that vascular access for arteriovenous hemofiltration in infants and small children provides sufficient blood flow through the device for ultrafiltrate production.

Blood Pressure↗
PubMed1988

Urinary infection and malformations of urinary tract in infancy.

One hundred and forty infants with their first urinary tract infections were studied and pronounced differences in age and sex were found. Two thirds of the patients had their first urinary tract infection during the first three months of life, and boys were significantly younger. There was a predominance of boys from 1-3 months old, but of girls thereafter. Obstructive uropathies occurred more often in boys, and during the first two months of life. The incidence of vesicoureteric reflux was similar for both sexes. Malformations recognised after urinary tract infections were compared with urinary tract malformations recognised prenatally. Fetal urinary tracts were evaluated in just over half of all pregnancies during the study period. Obstructive uropathies and multicystic dysplastic kidneys were more often diagnosed prenatally, and most refluxes were diagnosed after the urinary tract infection. In conclusion age and sex differences are common in urinary tract infection, and even though many urinary tract malformations were diagnosed prenatally this did not influence the high incidence of malformations recognised after urinary tract infection in infancy.

Age Factors↗
PubMed1988

Astrocyte overgrowth in the brain stem and spinal cord of mice affected by spinal atrophy, wobbler.

Biochemical and immunohistochemical analyses of the central nervous system (CNS) have been performed on the wobbler (WR) mouse, a mutant affected by a spinal atrophy. Total polypeptide patterns as well as specific neuronal and glial marker proteins were analyzed, using 2-dimensional gel electrophoresis, immunoblotting and ELISA, and the determination of enzyme activities. Despite the loss of motoneurons, the specific activities of choline acetyltransferase were not lower in WR than in control CNS samples. On the other hand, the level of glial acidic fibrillary protein (GFAP) was increased 3- to 5-fold in the spinal cord and brain stem of WR mice but not in the cerebellum. Immunohistochemistry indicated that the higher content of GFAP was due to a dense network of astrocytic processes extending over the whole cross-section of the spinal cord. This finding indicates that astrocyte overgrowth may be a fundamental feature of the wobbler disease, rather than occurring locally in response to motoneuron degeneration.

Animals↗
PubMed1988

Suction-supported continuous arteriovenous hemofiltration in children.

Spontaneous continuous arteriovenous hemofiltration (CAVH) may fail to control azotemia in small patients with renal failure due to poor blood flow. To produce adequate ultrafiltrate a continuous negative pressure was added to the ultrafiltrate line. Two hemofilter systems of different membrane and surface area were used. Suction support approximately doubled ultrafiltration rate in both hemofilters. No side effects such as severe hypotonia or early hemofilter clotting occurred. Added suction can serve as a useful support of spontaneous CAVH in children with renal failure and too poor a blood flow to control azotemia.

Acute Kidney Injury↗
PubMed1988

Anticoagulation for continuous arteriovenous hemofiltration in children.

Continuous arteriovenous hemofiltration requires continuous anticoagulation to prevent early hemofilter clotting. We used heparin given continuously in the arterial line of the extracorporeal circuit as anticoagulant in children with initially normal coagulation status, and heparin and/or prostacyclin in high-risk bleeding patients with preexisting coagulopathy. Heparin infusion enabled a mean running time of 22.2 +/- 9.6 h, with the 0.1-m2 hemofilter and of 26.6 +/- 4.7 h with the 0.25-m2 hemofilter. The mean filter running time with combined heparin/prostacyclin infusion was 31 +/- 8.8 h. Prostacyclin as the sole antithrombotic agent provided good filter function only in 1 patient with preexisting coagulopathy. No adverse effects such as bleeding thrombosis, or hypotension were observed.

Anticoagulants↗
PubMed1988

[Assessment of a commonly available latex particle agglutination test in rapid, bacteriologic cerebrospinal fluid diagnosis].

36 cerebrospinal fluid specimens (CSF) from patients with bacterial meningitis were tested for the presence of bacterial antigens with the "Slidex Meningite Kit" (Bio Merieux). This kit has latex particles coated with antibodies against hemophilus influenzae type B (Hib) streptococcus pneumoniae (SP) and neisseria meningitidis (NM) group A and C. With the LAT we could detect the bacterial antigens in 84% of bacterial meningitis cases, 23 of the 27 of Hib meningitis (85.2%), all of the 6 cases of SP meningitis (100%) and two of the three NM meningitis cases. The test is handicapped by the fact, that there is no antiserum against NM sero-group B, the main cause of NM meningitis in Austria. There were no false positive results with the LAT. False negative results were obtained in 19.2% of Hib and in one case of NM. Even under sufficient antibiotic therapy and with negative culture we could detect 9 Hib- and 1 NM-cases during the first 12-48 hours of therapy with this method. The LAT-Kit is a useful addition to standard methods of CSF examinations in bacterial meningitis. With the LAT a rapid bacteriological diagnosis is possible within 15 minutes. The Kit is also able to identify bacterial antigens even with negative culture and after initiation of antibiotic treatment.

Antigens, Bacterial↗
PubMed1988

[The initial presentation of renal tubular syndrome].

History, clinical presentation and first laboratory results were analyzed in three patients with cystinosis and in three patients with distal renal tubular acidosis. Growth failure, gastrointestinal tract disturbances, polydipsia, and polyuria were the most constant findings on history. Patients with distal renal tubular acidosis had a shorter period of clinical symptoms. All patients presented with dystrophy and dehydration. First laboratory investigation uniformly showed metabolic acidosis, high urinary-pH, and in spite of dehydration a low osmolarity of the first voided urine specimen. There were lower values of serum potassium and of urine osmolarity in cystinosis. In addition, metabolic acidosis was not so pronounced. Our study shows that history, clinical presentation and the results of a few simple laboratory investigations can indicate the presence of a renal tubular disorder even on admission of the patients.

Acidosis, Renal Tubular↗
PubMed1987

Continuous arteriovenous haemofiltration in children with postoperative cardiac failure.

Six children with refractory heart failure were treated by continuous arteriovenous haemofiltration. The cause of the failure was postoperative fluid overload or low cardiac output with anuria or oliguria. This produced a mean (2 SD) negative fluid balance of 1.4 (0.6) ml/kg/h and reduced mean (2 SD) body weight from 4.7 (2.2) to 4.2 (2.3) kg over a period of 57.5 (31.1) hours. Central venous pressure fell significantly from 13.7 (3.1) to 7.7 (0.7) mm Hg while the mean (2 SD) arterial pressure increased significantly from 44.6 (5.5) to 52.6 (5.1) mm Hg. In three infants urine production resumed when normal blood volume had been achieved. The other three infants needed further haemofiltration because of prolonged renal failure. All but one was weaned from artificial ventilation and catecholamine treatment. No adverse haemodynamic effects were noted. One child need operation for a femoral artery thrombosis after 12 days of continuous arteriovenous haemofiltration.

Female↗
PubMed1987

Continuous arteriovenous hemofiltration in critically ill children with acute renal failure.

Last year, five critically ill children with acute renal failure were treated by continuous arteriovenous hemofiltration. Mean treatment duration was 326 +/- 89 (SD)h, for a total of 1632 h. Mean ultrafiltration rates of 5.4 +/- 1.7 ml/min X m2 achieved mean serum urea levels of 150 +/- 25 mg/dl and a decline of mean prehemofiltration serum creatinine level of 3.5 +/- 3.6 to 2.9 +/- 2.0 mg/dl posthemofiltration. Continuous arteriovenous hemofiltration allowed adequate parenteral nutrition with a mean caloric intake of 79.6 +/- 9.2 kcal/kg X day. In the four surviving patients, urinary output started between 12 and 42 days after the onset of acute renal failure. Continuous arteriovenous hemofiltration is a very effective extracorporeal therapeutic system to control azotemia, fluid, and electrolyte balance in critically ill children with acute renal failure and hemodynamic instability.

Acute Kidney Injury↗
PubMed1987

[Continuous arteriovenous hemofiltration in childhood. Indications and technics].

CAVH is an extracorporal treatment modality by which fluid and solutes can be removed from the body by convective transport. Without using a blood pump the blood passes through the hemofilter driven only by the arteriovenous pressure gradient. From May 1985 to October 1986 18 critically ill children with a mean age of 5.1 years (range 10 days to 18 years) and a mean body weight of 20.8 kg (range 3 to 80 kg) were treated by CAVH. Indications for CAVH were: acute renal failure, multiple organ system failure, diuretic-resistant hypervolemia, interstitial pulmonary edema, electrolyte disorders, and metabolic crisis in maple syrup urine disease. Five different hemofilter systems with a membrane surface of 0.015 m2 to 0.6 m2 and an extracorporal filling volume of 9 to 70 ml were used. Mean duration of CAVH was 132 h (range 10 to 432 h), for a total time of 2344 h. Mean ultrafiltration rates ranged from 0.34 +/- 0.1 (SD) ml/min (Amicon Minifilter 0.015 m2) to 9.1 +/- 1.47 (SD) ml/min (Gambro FH55 0.6 m2). The application of a continuous negative pressure of 200 mmHg onto the ultrafiltrate line the ultrafiltrate increased from 3.96 +/- 0.62 (SD) ml/min to 13.4 +/- 1.63 (SD) ml/min. CAVH allowed good compensation of azotemia in critically ill children with acute renal failure, rapid correction of severe hypervolemia, interstitial pulmonary edema, electrolyte disorders, and metabolic crisis in maple syrup urine disease. It was well tolerated by all children. The only complication due to hemofiltration was a femoral artery thrombosis which needed surgical revision.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Kidney Injury↗
PubMed1987

Arteriovenous hemofiltration in children with multiple organ system failure.

In the last year nine critically ill children with multiple organ system failure (MOSF) were treated by continuous arteriovenous hemofiltration (CAVH). The mean number of organ systems involved was five per patient (range 4 to 7). Mean duration of hemofiltration was 136 hours (range 10 to 432 h.). Mean ultrafiltration rates of 6.4 +/- 3.0 ml/m2 b.s./min achieved mean serum creatinine levels of 2.39 +/- 1.49 mg/dl. Hypervolemia and pulmonary edema were corrected rapidly by CAVH. Total parenteral nutrition with a mean caloric intake of 62 +/- 15 kcal/kg b.w./day was provided throughout the hemofiltration period. In addition high ultrafiltration rates allowed delivery of large amounts of i.v. medications. CAVH is an ideal extracorporeal renal replacement system to control azotemia, fluid, electrolyte, and acid-base status in critically ill children. It carries the potential to improve survival rate in children with MOSF.

Adolescent↗
PubMed1987

Continuous arteriovenous renal replacement therapy.

As urea and creatinine clearances achieved by continuous arteriovenous hemofiltration tend to be low, efforts were made to increase urea and creatinine elimination by modifying the original continuous arteriovenous hemofiltration system. We investigated the urea and creatinine clearances of different continuous renal replacement therapy systems. Urea clearance achieved by spontaneous arteriovenous hemofiltration was 9.1 ml/min, suction-supported arteriovenous hemofiltration 15.3 ml/min, arteriovenous hemodiafiltration 15.4 to 19.3 ml/min, arteriovenous hemodialysis 18.9 to 22.1 ml/min. Creatinine clearances ranged between 11.1 (spontaneous arteriovenous hemofiltration) and 25.1 ml/min (arteriovenous hemodialysis). Continuous arteriovenous hemodialysis seems at present to be the ideal renal replacement therapy system to compensate azotemia in hypercatabolic patients. Its urea and creatinine clearances are high, its clinical tolerance good and it is simple and safe.

Child↗
PubMed1986

Arteriovenous haemofiltration in hypervolaemia.

Arteriovenous haemofiltration was used for removal of fluid overload in a 9 month old burned infant with diuretic resistant hypervolaemia. After 60 hours of arteriovenous haemofiltration hypervolaemia had disappeared. Arteriovenous haemofiltration proved to be a safe and simple extracorporal method of managing severe fluid overload.

Blood↗