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Biomedical subjects

I Julander

Publications and source records attributed to I Julander.

63 records · Page 4Linked to original sources
PubMed1983

Intravenous drug addiction--staphylococcal septicemia--pulmonary embolism: a triad pathognomonic for tricuspid valve endocarditis?

28 patients (29 episodes) presenting the triad of intravenous narcotic drug addiction, Staphylococcus aureus septicemia and septic pulmonary embolism were examined for the presence of tricuspid valve endocarditis. In a prospective study, 12/13 patients examined by echocardiography had vegetations on the tricuspid valve, in 6 detected by M-mode, in 5 by 2-D technique, and in one by both methods. In 4 patients with tricuspid endocarditis, no significant murmurs were heard. Similarly, in a retrospective study, 5/16 patients not subjected to echocardiography had no murmurs consistent with tricuspid valve endocarditis. One of these patients died. In 2/16 patients the diagnosis was verified at autopsy and in 1 at heart surgery. In both groups, altogether 11 patients never developed murmurs, in 7 of them despite demonstrable vegetations. Therefore, we consider the triad to be pathognomonic for tricuspid valve endocarditis, provided that no peripheral source of emboli is present. Consequently, patients fulfilling these criteria should be treated as suffering from endocarditis. Echocardiographic examination does not seem necessary in patients with a typical clinical picture but may be helpful when chest X-rays are inconclusive or complications are suspected.

Adult↗
PubMed1983

Serological diagnosis of deep Staphylococcus aureus infections by enzyme-linked immunosorbent assay (ELISA) for staphylococcal hemolysins and teichoic acid.

An enzyme-linked immunosorbent assay (ELISA) was used with a purified alpha-toxin preparation to measure the serum IgG, IgM and IgA response in staphylococcal septicaemia and endocarditis. ELISA for IgG antibodies against alpha-toxin was found to be more sensitive than the neutralization test (ASTA). IgM and IgA antibody determination was found to be of limited diagnostic value. A correlation between IgG antibodies to alpha-toxin and purified beta-toxin was found in ELISA, although antibody determination to beta-toxin was a less sensitive diagnostic method. The highest diagnostic sensitivity in deep staphylococcal infections was obtained by parallel performance of ELISA to alpha-toxin and purified teichoic acid. By this approach, 32/35 (91%) patients with endocarditis, 12/14 (86%) with complicated septicaemia and 15/22 (68%) with uncomplicated septicaemia showed increased titres in samples drawn between days 7-30 of disease. Diagnostic sensitivity was further increased to 31/32 (97%) positive patients, when paired or multiple samples from patients with septicaemic staphylococcal disease were analysed.

Antibodies, Bacterial↗
PubMed1983

Staphylococcal septicaemia and endocarditis in 80 drug addicts. Aspects on epidemiology, clinical and laboratory findings and prognosis.

During 1965-1980, 80 intravenous drug addicts with staphylococcal septicaemia with or without endocarditis were admitted to the Roslagstulls Hospital. The mean age was 28.8 (range 16-57) years. 42 were females and 38 were males. Endocarditis was diagnosed in 36 of 80 (45%) and suspected in 18 of 80 (22.5%). Septicaemia alone was found in the remaining 26 patients (32.5%). The median interval between onset of disease and institution of adequate therapy for patients without endocarditis was four days and for endocarditis cases eight days. Most patients had septic toxic symptoms. Respiratory tract symptoms were most common in patients with tricuspid valve endocarditis. Tricuspid valve engagement, manifested as pulmonary septic embolism, was present in 33 of 36 (91.7%) of the episodes of endocarditis. Among these patients, murmurs were only present in 23. Haematuria was significantly more often found in patients with endocarditis than in other groups of patients. Otherwise, laboratory data could not differentiate between patients with or without endocarditis. The outcome was lethal in five patients (6.3%): Tricuspid endocarditis (one); left-sided endocarditis (two); suspected endocarditis and retrosternal abscess (one); septicaemia (one). An unfavourable outcome was correlated to patient's delay, severe underlying diseases and/or lack of co-operation. By 1983 another 12 of the patients had died, two of them from endocarditis and one from pneumonia.

Adolescent↗
PubMed1982

Septicaemia and endocarditis--uncommon but serious complications in connection with permanent cardiac pacing.

Between 1971 and 1978 septicaemia was observed in 14 patients undergoing permanent pacemaker treatment. The causative microorganisms were: S. aureus (9), S. epidermidis (3), alfa-haemolytic streptococci + P. morganii (1), enterococci (1). In 4 patients, a mural endocarditis of the right atrial wall surrounding the electrode was found at operation or autopsy. The interval between the preceding pacemaker operation and onset of septicaemia varied between 2 days and 23 months (median 2 months). In 5 patients, the last operation before septicaemia was performed because of local infection in the pacemaker pocket or along the electrode. A probable portal of entry was found in 11 patients. The electrode was the origin in 8, the pacemaker pocket in one, and a focus outside the pacemaker system in 2. Of the 6 patients treated with antibiotics alone, 3 were cured, 2 died and one is still on treatment. Eight patients underwent various surgical procedures in addition to the antibiotic treatment. In 4 the electrode was completely removed. In 2 of them cardiotomy during extracorporeal circulation had to be used. All of these patients were cured. In 3 the pacemaker system was partially extracted. Only one of them was cured, one developed osteomyelitis and one died. Based on our experience, we now recommend that all foreign material should be removed, if possible, in the presence of septicaemia and/or endocarditis, and that parenteral antibiotic treatment should be given for at least 6 weeks.

Aged↗
PubMed1980

Haemophilus parainfluenza--an uncommon cause of septicemia and endocarditis.

6 cases of endocarditis and 1 of septicemia caused by Haemophilus parainfluenzae have been observed in our hospital from 1970 to 1977, as against no case from 1957 to 1969. The mean age of the patients was 46 years. The clinical picture did not differ from that seen in cases of septicemia and endocarditis from other cases. In 4 cases no underlying heart disease was known. In 2 of them, endocarditis developed in the mitral and in 1 in the aortic valve. Of 3 patients with preexisting heart disease, 2 had involvement of the aortic valve and 1 of the mitral valve. Six patients were cured, 2 or possible 3 by treatment with ampicillin, 2 with cephalothin, and 1 with co-trimoxazole. In 2 patients intractable heart failure necessitated the insertion of prosthetic valves, and 1 patient died. Thus, cases of septicemia and endocarditis due to H. parainfluenzae have been observed only in recent years and they appear to be serious infections.

Endocarditis, Bacterial↗
PubMed1978

Netilmicin treatment of serious infections in patients with renal insufficiency.

Out of 24 patients with suspected moderate to severe infections and treated with the semisynthetic aminoglycoside netilmicin, 11 patients had decreased renal function. Non-bacterial aetiology was present in five cases. There was good netilmicin effect in 10 cases, indeterminate effect in 6 cases (due to simultaneously given other antibiotics) and failure in 3 cases. Pharmacokinetic parameters were studied. Curves are given for serum concentration patterns relative to creatinine clearance, and serum half-lives are calculated in renal dysfunction. In this series of very ill patients including impaired renal function, metilmicin proved to be an efficient antibiotic with low toxicity. Only one transient minor vestibular abnormality in an 80-year-old man with concomitant diuretic medication was registered.

Aged↗
PubMedDate not supplied

Elevated serum beta-2-microglobulin--a prognostic marker for development of AIDS among patients with persistent generalized lymphadenopathy.

For evaluation of its prognostic value, the level of serum beta-2-microglobulin was determined in early serum samples from 88 patients with persistent generalized lymphadenopathy in a prospective longitudinal study. Patients with serum beta-2-microglobulin greater than 2.6 mg/l were found to have a significantly higher risk of developing AIDS earlier when compared to patients with a lower level (p less than 0.001).

AIDS-Related Complex↗
PubMedDate not supplied

Septicemia and endocarditis, 1965-1980, in a Swedish university hospital for infectious diseases.

A 16-year (1965-1980) retrospective clinical study of septicemia and endocarditis was performed at a hospital for infectious diseases. 634 patients (74.5%) had septicemia, 138 (16.2%) endocarditis and 79 (9.3%) suspected endocarditis. The mean age was 55 years, 472 were males and 379 females. Predisposing underlying conditions were recognized in 89.2%. Gram-positive cocci (62.3%) dominated over gram-negative rods (29.5%). The most common causative organisms of septicemia were Staphylococcus aureus (22.4%) and Escherichia coli (20.2%), and of endocarditis, S. aureus (47.1%) and alpha haemolytic streptococci (21.0%). The overall fatality rate was 17.7% and was highest in infections caused by gram-negative rods and S. aureus. In septicemia the rate was 15.3% and in endocarditis 37.0%. Unfavourable prognostic factors were high age, endocarditis and underlying conditions such as haematological diseases and various other factors.

Adult↗