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Biomedical subjects

I Julander

Publications and source records attributed to I Julander.

At least 55 records · Page 3Linked to original sources
PubMed1988

Bacteremic pneumococcal pneumonia in Sweden: clinical course and outcome and comparison with non-bacteremic pneumococcal and mycoplasmal pneumonias.

279 patients with 285 episodes of bacteremic pneumococcal pneumonia (Pnb), treated at the 2 departments for infectious diseases in Stockholm, Sweden, were reviewed retrospectively. Almost half of all episodes were caused by serotypes 3, 9 and 4 (in that order). The overall mortality rate was 7% and as low as 5% if patients with extrapulmonary complications were excluded. As in other studies male sex, alcoholism and absence of leukocytosis on admission to hospital were all associated with a higher mortality rate. However, the prognosis for old patients was much better than in most other studies. This was true also when the infecting strain was of serotype 3. For 89 consecutive patients out of the 279 ones with Pnb the clinical, laboratory and chest X-ray data were compared with those of 44 patients with non-bacteremic pneumococcal pneumonia (Pn) and 27 patients with Mycoplasma pneumoniae pneumonia (MP). Within the pneumococcal group almost all non-bacteremic patients had respiratory tract symptoms compared to less than half of the patients with bacteremic disease. High age, alcoholism, chills, pleuritic chest pain, a leukocyte count of greater than 15 x 10(9)l and an elevated CRP were factors significantly more common among those with pneumococcal pneumonia than among the MP patients. On chest X-ray an alveolar pattern was seen in all but 2 of the totally 133 patients with a pneumococcal pneumonia, but also in half the patients with MP.

Adolescent↗
PubMed1987

Acyclovir treatment in infectious mononucleosis: a clinical and virological study.

Fifty-six patients with a clinical and laboratory diagnosis of infectious mononucleosis who had not been ill for more than seven days, were randomised for peroral treatment with acyclovir (800 mg five times daily) or placebo for seven days in a double blind trial. Clinical, virological and immunological parameters were monitored in each patient for six months. During treatment, shedding of Epstein-Barr virus' as assessed in 36 patients, was significantly reduced (p less than 0.001). However, virus production in the oropharynx returned to pre-treatment levels one week after the cessation of therapy. Virus was detected in 35 patients at enrollment and in 28 of 36 patients at the six-month control. No effect on the clinical course of the disease was noticed. The virus-specific antibody response was also unaffected. A significant reduction in spontaneous outgrowth of in vivo Epstein-Barr virus-infected B-lymphocytes was found at 180 days after treatment in four acyclovir-treated patients compared to six controls (p less than 0.001). In another three patients with over-whelming clinical symptoms causing airway obstruction and/or disseminated intravascular coagulopathy, treatment with intravenous acyclovir (10 mg/kg three times daily) was combined with prednisolone (0.7 mg/kg daily) for ten days. Virus shedding ceased transiently during treatment, but returned to initial levels within one week. A dramatic clinical effect on the pharyngeal oedema and general health of the two patients with airway obstruction was noticed, but was much less evident in a patient with intravascular coagulopathy.

Acyclovir↗
PubMed1986

Suppurative Staphylococcus aureus thyroiditis.

Suppurative thyroiditis with septicaemia caused by Staphylococcus aureus in a 65-year-old male patient with diabetes mellitus was diagnosed by needle aspiration. Antibiotic treatment and surgical drainage cured the patient.

Aged↗
PubMed1986

Are white blood cell count, platelet count, erythrocyte sedimentation rate and C-reactive protein useful in the diagnosis of septicaemia and endocarditis?

In 851 predominantly adult patients with septicaemia or endocarditis data regarding white blood cell (WBC) count, platelet count, ESR and C-reactive protein (CRP) obtained within 3 days of admission were analyzed retrospectively. Among 232 patients with complete laboratory data none had the combination of normal ESR, negative CRP and lack of both leukocytosis and thrombocytopenia. CRP was positive (greater than 10 mg/l) in 93%, ESR was elevated (greater than 20 mm/h) in 90%, leukocytosis (WBC greater than 9 X 10(9)/l) was present in 60% and thrombocytopenia (platelets less than 150 X 10(9)/l) in 35% of the patients. Patients with pneumococcal infection had generally higher ESR and CRP values and WBC counts than patients with other infections.

Blood Sedimentation↗
PubMed1985

Occurrence of P-fimbriated Escherichia coli in patients with bacteremia.

The case history of 88 patients with blood cultures positive for Escherichia coli and evidence of systemic disease was reviewed, and the Escherichia coli blood isolates tested for P-fimbriation. Fifty-five strains (63%) were P-fimbriated. Patients with a positive urine culture had a higher incidence of P-fimbriated Escherichia coli strains (53/75, 71%) than patients with a negative urine culture (2/13, 15%). Patients with no predisposing factors, such as instrumentation of the urinary tract or a chronic disease, had a significantly higher frequency of P-fimbriated strains (31/36, 86%) compared to patients without such underlying factors (p less than 0.01). There was no significant difference in clinical parameters or in frequency of P-fimbriated strains between patients with one positive blood culture and those with two or more positive cultures. The high incidence of P-fimbriated Escherichia coli strains in these patients is thought to depend on the ability of such bacteria to cause acute pyelonephritis, which in many cases precedes Escherichia coli bacteremia.

Adhesiveness↗
PubMed1985

Prediction of staphylococcal etiology among patients with septicemia with or without endocarditis by multivariate statistical methods.

Multivariate statistical methods, multiple regression (RA) and automatic interaction detector analysis (AID) were used to study the possibility of an early prediction of staphylococcal etiology in 249 of 851 patients with verified septicemia or endocarditis. The variables included pertinent symptoms and signs and laboratory data available soon after admission. 10 of the 70 variables initially studied showed simple, or in various combinations, a statistically significant partial correlation to staphylococcal etiology in the AID. The highest predictive value with a high probability for staphylococcal etiology was recorded for combinations of the variables: i.v. narcotic addiction and septic pulmonary embolism; non-addiction, wound infection, and hospitalization within 4 weeks; non-addiction, absence of skin infection, presence of foreign body, and age less than 60 yr. Staphylococcal etiology was contradicted by the absence of i.v. narcotic addiction, skin infection, foreign body, septic skin manifestation, surgical procedure within 4 weeks, joint symptom and a C-reactive protein less than or equal to 10 mm. Thus, a prediction of etiology may be valuable in choosing therapy before definite confirmation by positive blood cultures or when blood cultures remain sterile.

Adolescent↗
PubMed1985

Serum triglyceride elevations in patients with septicemia.

Among 239 patients with septicemia or endocarditis 41 (17%) had serum triglyceride levels in excess of 2.2 mmol/l (mean 3.1 mmol/l). This was more common in infectious with gram-negative rods than gram-positive cocci (p less than 0.001). A return to normal levels occurred in 22/37 patients during the course of the infection.

Cholesterol↗
PubMed1985

Unfavourable prognostic factors in Staphylococcus aureus septicemia and endocarditis.

Factors predictive of a fatal outcome were retrospectively studied in 248 patients admitted with Staphylococcus aureus septicemia during 1965-1982, 78 of whom had endocarditis. 77 patients were intravenous drug addicts and 47 of them had endocarditis. 48 patients (19.4%) died. The fatality rate in addicts and non-addicts from septicemia was 0% and 17.9% and from endocarditis 8.5% and 61.3%, respectively. After analyzing clinical and laboratory data available early in the course of the disease 4 risk factors were found both in septicemia and endocarditis: age greater than or equal to 60 yr, pre-existing cardiovascular disease, prior hospitalization within 30 days of onset of illness, and neurological symptoms and/or signs. In addition, in endocarditis a platelet count before therapy less than 100 X 10(9)/l and left-sided involvement were unfavourable prognostic factors.

Adolescent↗
PubMed1985

NBT-reduction for detection of specific, opsonizing antibodies against haemophilus parainfluenzae.

Specific, opsonizing antibodies against Haemophilus parainfluenzae were demonstrated in serum by measuring their enhancing effect on the nitroblue tetrazolium (NBT)-reduction of normal human granulocytes, phagocytizing the homologous bacteria. Patients with septicemia and/or endocarditis and carriers of H. parainfluenzae were studied. In late phase sera of the first group such antibodies were detected in 6 of 9 cases. Opsonizing antibodies against H. parainfluenzae were not detected in any of the carrier sera. A dose-response effect was observed when a positive late phase serum was tested in serial 2-fold dilutions. The enhancement of the NBT-reduction was eliminated by absorption of serum with homologous antigen. The detection of opsonizing antibodies, essential for the immune defense against H. parainfluenzae might be helpful for evaluation of the pathogenicity of this organism, which so far is considered as a rare causative agent.

Adolescent↗
PubMed1984

Antibiotic prophylaxis in pacemaker surgery--a prospective study.

To evaluate the effect of antibiotic prophylaxis in pacemaker surgery, 100 patients were randomly assigned to a prophylaxis group receiving cloxacillin or to a control group with no antibiotics. Cloxacillin was given intravenously (2 g) 2 hours before operation, followed by 1 g every 6 hours for 2 days and the same dose perorally for 8 more days postoperatively. Adequate plasma concentrations were obtained in all patients. The follow-up time was 1-43 months. The infection rate was 2% (1/50) in the prophylaxis group and 14% (7/50) in the control group (p less than 0.05). The interval from operation to manifest infection was 9-35 days. In the control group the causal microorganism was Staphylococcus aureus in two patients, Staphylococcus epidermidis in two and unknown in three patients. In the only patient with infection in the prophylaxis group, a methicillin-resistant S. epidermidis was isolated. Infection was initially localized to the pacemaker pocket in seven patients, but septicemia developed in one of them and endocarditis in another. In one patient septicemia appeared initially, without local signs of infection. This study suggests that cloxacillin prophylaxis is of value in routine pacemaker surgery.

Aged↗
PubMed1983

The effect of intralipid on mononuclear and polymorphonuclear phagocytes.

Eight healthy subjects were given Intralipid, a soybean oil emulsion, 20% intravenously for 2 h. During the infusion a significant increase in the nitroblue tetrazolium-reduction of blood monocytes was noted. Preincubation of monocytes in vitro with Intralipid (20 to 100 mg/ml) for 30 min was found to increase the ability of the cells to migrate chemotactically and to phagocytize yeast particles. On the contrary, when neutrophilic granulocytes were preincubated with Intralipid in the same concentrations for 30 min. their nitroblue-tetrazolium-reduction, chemotactic and spontaneous locomotion, as well as their ingestion of yeast particles was depressed.

Adult↗
PubMed1983

Coagulase-negative staphylococci and cloxacillin prophylaxis in pacemaker surgery.

In a prospective study of cloxacillin prophylaxis at pacemaker surgery per- and post-operative cultures were made. The most commonly isolated organisms from the wound were coagulase-negative staphylococci. These were typed by the scheme devised by Kloos and Schleifer. The routinely performed per-operative culture was of very little prognostic value. However, the typing was found to be useful in cases with suspected infection, as repeated isolation of the same species of coagulase-negative staphylococci with the same antibiotic susceptibility pattern may indicate pathogenicity. Incubation in enrichment medium for 2-4 days was needed in one patient who received antibiotic therapy when the specimen for culture was taken. The antibiotic prophylaxis did not eradicate even susceptible bacteria from the wound, but the infection rate was significantly lower in the prophylaxis group.

Adult↗