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Biomedical subjects

J Jacobi

Publications and source records attributed to J Jacobi.

At least 37 records · Page 2Linked to original sources
PubMed1998

Nephroprotection by antihypertensive therapy.

Morbidity and mortality due to end-stage renal failure has become a major health concern in recent years and there is clear evidence that arterial hypertension constitutes a powerful risk factor for the progression of renal disease. Several studies have documented the benefit of blood pressure control on renal function, and it is increasingly recognized that antihypertensive therapy aimed at reducing blood pressure well below the target value of 140/90 mmHg further improves the overall renal survival rate. Different classes of antihypertensive agents show disparate specific nephroprotective properties that are unrelated to their blood pressure lowering properties. ACE inhibitors and calcium channel blockers have been reported to ameliorate renal function by favorably modifying renal and intraglomerular hemodynamics. In addition, both drugs exert beneficial effects on non-hemodynamic parameters of renal function. In contrast, beta-blockers and diuretics, although still being solely recommended as first line drugs in the management of arterial hypertension, can have adverse effects on renal function. Recently, long-term randomized controlled trials have consistently demonstrated the superior nephroprotective value of ACE inhibitors on renal function outcome. Whether AT1 receptor antagonists have similar effects on long-term renal survival is still under investigation. The outcome of forthcoming clinical trials is likely to influence clinical guidelines and optimize the medical regimen of human essential hypertension in patients with chronic renal insufficiency.

Antihypertensive Agents↗
PubMed1998

Practice guidelines for evaluating new fever in critically ill adult patients. Task Force of the Society of Critical Care Medicine and the Infectious Diseases Society of America.

OBJECTIVE: The development of practice guidelines for evaluating adult patients who develop new fever in the intensive care unit (ICU) for the purpose of guiding clinical practice. PARTICIPANTS: A task force of 13 experts in disciplines related to critical care medicine, infectious diseases, and surgery was convened from the membership of the Society of Critical Care Medicine and the Infectious Disease Society of America. EVIDENCE: The task force members provided personal experience and determined the published literature (articles retrieved with use of MEDLINE or textbooks) from which consensus would be sought. The published literature was reviewed and classified into one of four categories, according to study design and scientific value. CONSENSUS PROCESS: The task force met several times in person and twice monthly by teleconference over a 1-year period to identify the pertinent literature and arrive at consensus recommendations. Consideration was given to the relationship between the weight of scientific evidence and the experts' opinions. Draft documents were composed and debated by the task force until consensus was reached by nominal group process. CONCLUSIONS: The panel concluded that because fever can have many infectious and noninfectious etiologies, a new fever in an adult patient in the ICU should trigger a careful clinical assessment rather than automatic orders for laboratory and radiological tests. A cost-conscious approach to obtaining diagnostic studies should be undertaken if they are indicated after a clinical evaluation. The goal of such an approach is to determine, in a directed manner, whether infection is present so that additional testing can be avoided and therapeutic options can be identified.

Adult↗
PubMed1998

Practice parameters for evaluating new fever in critically ill adult patients. Task Force of the American College of Critical Care Medicine of the Society of Critical Care Medicine in collaboration with the Infectious Disease Society of America.

OBJECTIVE: To develop practice parameters for the evaluation of adult patients who develop a new fever in the intensive care unit (ICU) for the purpose of guiding clinical practice. PARTICIPANTS: A task force of 13 experts in disciplines related to critical care medicine, infectious diseases, and surgery was convened from the membership of the Society of Critical Care Medicine, and the Infectious Disease Society of America. EVIDENCE: The task force members provided the personal experience and determined the published literature (MEDLINE articles, textbooks, etc.) from which consensus would be sought. Published literature was reviewed and classified into one of four categories, according to study design and scientific value. CONSENSUS PROCESS: The task force met several times in person and twice monthly by teleconference over a 1-yr period of time to identify the pertinent literature and arrive at consensus recommendations. Consideration was given to the relationship between the weight of scientific evidence and the experts' opinions. Draft documents were composed and debated by the task force until consensus was reached by nominal group process. CONCLUSIONS: The panel concluded that, because fever can have many infectious and noninfectious etiologies, a new fever in a patient in the ICU should trigger a careful clinical assessment rather than automatic orders for laboratory and radiologic tests. A cost-conscious approach to obtaining cultures and imaging studies should be undertaken if it is indicated after a clinical evaluation. The goal of such an approach is to determine, in a directed manner, whether or not infection is present, so additional testing can be avoided and therapeutic options can be made.

Adult↗
PubMed1996

Combination antibiotic therapy in critically ill patients.

Combination antibiotic therapy may be used for a number of reasons in critically ill patients. The potential benefits of combination therapy include prevention of resistance, treatment of polymicrobial infections, to decrease toxicity, or for synergy. Selected literature is reviewed which examines the use of combination therapy in critically ill patients. Research reports have not uniformly demonstrated the benefits of combination therapy. The situations where combination therapy has been beneficial are discussed.

Bacterial Infections↗
PubMed1995

Practice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit: an executive summary. Society of Critical Care Medicine.

OBJECTIVE: The development of practice parameters for intravenous analgesia and sedation for adult patients in the intensive care unit (ICU) setting for the purpose of guiding clinical practice. PARTICIPANTS: A task force of more than 40 experts in disciplines related to the use of analgesic and sedative agents in the ICU was convened from the membership of the American College of Critical Care Medicine (ACCM) and the Society of Critical Care Medicine (SCCM). EVIDENCE: The task force members provided the personal experience and determined the published literature (MEDLINE articles, textbooks, pharmacopeias, etc.) from which consensus would be sought. Published literature was reviewed and classified into one of four predetermined categories, according to study design and scientific value. CONSENSUS PROCESS: The task force met several times as a whole, and numerous times in smaller groups by teleconference, over a 1-yr period to identify the pertinent literature and arrive at consensus recommendations for the whole task force to discuss. Consideration was given to the relationship between the weight of scientific information and the experts' viewpoints. Over the next year, draft documents were composed by a task force steering committee and debated by the task force members until consensus was reached by nominal group process. The task force draft was then reviewed, assessed, and edited by the Board of Regents of the ACCM. After steering committee approval, the draft document was reviewed and approved by the SCCM Council. DATA SYNTHESIS: To facilitate rapid communication of the six recommendations contained within the complete and unabridged practice parameter document, an executive summary was prepared for publication by the ACCM Board of Regents, and this executive summary was approved by the task force steering committee and the SCCM Executive Council. CONCLUSIONS: A consensus of experts provided six recommendations with supporting data for intravenous analgesia and sedation in the ICU setting: a) morphine sulfate is the preferred analgesic agent for critically ill patients; b) fentanyl is the preferred analgesic agent for critically ill patients with hemodynamic instability, for patients manifesting symptoms of histamine release with morphine, or morphine allergy; c) hydromorphone can serve as an acceptable alternative to morphine; d) midazolam or propofol are the preferred agents only for the short-term (< 24 hrs) treatment of anxiety in the critically ill adult; e) lorazepam is the preferred agent for the prolonged treatment of anxiety in the critically ill adult; f) haloperidol is the preferred agent for the treatment of delirium in the critically ill adult. This executive summary selectively presents supporting information and is not intended as a substitute for the complete document.

Adult↗
PubMed1995

Practice parameters for sustained neuromuscular blockade in the adult critically ill patient: an executive summary. Society of Critical Care Medicine.

OBJECTIVE: The development of practice parameters for achieving sustained neuromuscular blockade in the adult critically ill patient for the purpose of guiding clinical practice. PARTICIPANTS: A task force of more than 40 experts in disciplines related to the use of neuromuscular blocking agents in the intensive care unit was convened from the membership of the American College of Critical Care Medicine (ACCM) and the Society of Critical Care Medicine (SCCM). EVIDENCE: The task force members provided the personal experience and determined the published literature (MEDLINE articles, textbooks, pharmacopeias, etc.) from which consensus would be sought. Published literature was reviewed and classified into one of four predetermined categories, according to study design and scientific value. CONSENSUS PROCESS: The task force met several times as a whole, and numerous times in smaller groups by teleconference, over a 1-yr period to identify the pertinent literature and arrive at consensus recommendations for the whole task force to discuss. Consideration was given to the relationship between the weight of scientific information and the experts' viewpoints. Over the next year, draft documents were composed by a task force steering committee and debated by the task force members until consensus was reached by nominal group process. The task force draft was then reviewed, assessed, and edited by the Board of Regents of the ACCM. After steering committee approval, the draft document was reviewed and approved by the SCCM Council. DATA SYNTHESIS: To facilitate rapid communication of the three recommendations contained within the complete and unabridged practice parameter document, an executive summary was prepared for publication by the ACCM Board of Regents, and this executive summary was approved by the task force steering committee and the SCCM Executive Council. CONCLUSIONS: A consensus of experts provided three recommendations with supporting data for achieving sustained neuromuscular blockade in critically ill patients: a) pancuronium is the preferred neuromuscular blocking agent for most critically ill patients; b) vecuronium is the preferred neuromuscular blocking agent for those patients with cardiac disease or hemodynamic instability in whom tachycardia may be deleterious; c) patients receiving neuromuscular blocking agents should be appropriately assessed for the degree of blockade that is being sustained. This executive summary selectively presents supporting information and is not intended as a substitute for the complete document.

Adult↗
PubMed1991

Cell kinetics in parathyroid adenomas: evidence for decline in rates of cell birth and tumour growth, assuming clonal origin.

OBJECTIVE: We aimed to provide a cell kinetic explanation for the demonstrated lack of disease progression in most patients with mild, asymptomatic primary hyperparathyroidism. DESIGN: We compared cell birth rates, estimated at the time of adenoma excision, with the lowest birth rates needed to grow tumours of the observed size. PATIENTS: Sixty-three patients with primary hyperparathyroidism due to a single chief cell adenoma who had normal renal function were followed up for long enough to demonstrate cure after surgical excision. MEASUREMENTS: Fresh adenoma tissue was incubated with tritiated thymidine. The proportion of cells synthesizing DNA was determined directly by radioautography in 18 cases, and indirectly from the regression of label index on rate of DNA synthesis in 45 cases. The birth rate of new cells was calculated assuming the duration of S phase to be 12 hours. The number of cells in each adenoma was estimated both from parenchymal weight and from total DNA content, and the minimum birth rate needed to produce this number of cells from a single cell, beginning in utero, was calculated on an exponential model. RESULTS: The mean observed birth rate of new cells (mean (SD)) was 17.3 (11.1)%/year, and the minimum needed birth rate was 42.8 (21.6)%/year, significantly, (P less than 0.001) higher than the observed birth rate. CONCLUSIONS: The rate of mitosis had fallen substantially during the life span of most parathyroid adenomas. To account for this, we propose that the mutation implied by a clonal origin increases the secretory setpoint. Because proliferation, as well as hormone secretion, is influenced by calcium in parathyroid cells, the expected result would be rapid initial growth, slowing down as tumour size reached an asymptotic value corresponding to the total rate of hormone secretion needed to raise the plasma calcium to the new setpoint.

Adenoma↗
PubMed1983

Loss of nitroglycerin to cardiopulmonary bypass apparatus.

An in vitro model of a cardiopulmonary bypass (CPB) circuit using a bubble oxygenator was developed to assess the potential of this system to extract nitroglycerin (NTG). A NTG solution (100 ng/ml) was circulated through a CPB circuit at 5 L/min for 60 min. Samples obtained for NTG analysis revealed a significant loss of drug to the circuit. By 60 min, only 18% of the initial NTG concentration was present. In a separate experiment, the bubble oxygenator was shown to be the major source of drug extraction because less than 15% of the drug concentration infused directly into the oxygenator appeared in the arterial outlet. These results indicate that patients may not receive the expected dose of NTG during CPB even if caution is taken to administer the drug through nonadsorbing iv tubing.

Biological Availability↗
PubMed1981

[Cadmium constant of food and human organs in one large city].

The cadmium contents of commercial foods and of meal samples from a factory canteen were examined over a period of 2 years and of 4 months, respectively. Furthermore, the cadmium contents of human organ samples obtained at necropsy were determined. The samples were subjected to wet digestion and analyzed by atomic absorption spectrophotometry. The value found for the cadmium intake by foods did not differ from international data. On the basis of the average cadmium values from the present investigation and of the per capitum consumption of the GDR population, the authors calculated a weekly cadmium intake from the major foods that amounts to approximately 50% of the WHO/FAO value. The cadmium contents of the human organ samples obtained at necropsy were somewhat lower than those from comparable foreign studies.

Brain Chemistry↗
PubMed1980

[Heavy metal content of cereals and potatoes].

By means of atomic absorption spectrometry, the authors determined the cadmium, zinc, copper and manganese contents in potatoes and cereals from three territories differently burdened by heavy-metal immissions (rural region, overcrowded urban region, region with non-ferrous metal industry). Of these elements, cadmium was most enriched, followed (by a wide margin) by zinc and copper, whereas the manganese level was slightly higher in the burdened region II (compared to the burdened region I) and somewhat lower in the burdened region III. Compared to normal values (0.035--0.080 p.p.m.), i. e., values found in non-burdened regions, the cadmium contents were some 2- to 6-fold higher in air-dry samples of wheat, barley and rye from the burdened regions, some 30-fold higher in oats, and some 3- to 4-fold higher in potatoes (normal values, on a dry-weight basis, (0.140 p.p.m.). As to cereals, the zinc levels were, at the most, some 2-fold higher than the normal values (29--34 p.p.m.), the copper contents were, at the most, some 1.5-fold higher than the normal values (4.1 bis 4.8 p.p.m.), whereas the manganese levels (normal values, 14--30 p.p.m.) were less by half. In potatoes, the zinc contents were but slightly higher than the normal values (18.5 p.p.m., on a dry-weight basis), the copper levels (4.6 p.p.m., on a dry-weight basis) were some 2-fold higher, and the manganese contents (7.2 p.p.m., on a dry-weight basis) were somewhat reduced. On an average 26% (region with non-ferrous metal industry) or 13% (normal region) of the heavy metals are removable from potatoes by washing. On the basis of the results obtained and of data from the literature, an estimate is calculated for the expected values in territories differently burdened by heavy-metal immissions. Finally, targeted suggestions are given for preventing or impeding the entrance of heavy metals into the biocycle.

Cadmium↗
PubMed1979

[Cadmium content of vegetable foods in the effective range of a lead smelting plant].

In the effective range of a lead smelting plant, the repercussions of cadmium emissions (mainly past) on vegetables, fruit, soil and drinking water as well as of immissions were investigated by means of atomic absorption spectrometry. As compared to the "normal" cadmium level, the cadmium contents in vegetables and fruit were some 2- to 85-fold higher; and those in soils, some 70- to 230-fold. The mean contents in vegetables ranged from 0.4 to 25.5 p.p.m. (on a dry-weight basis); those in fruit, from 0.09 to 1.17 p.p.m. Cadmium concentrations varying from 6.8 to 22.8 p.p.m. were found in soil samples. The drinking water contained 0.009 p.p.m. of cadmium. The mean cadmium contents in the atmosphere and the sedimentary dust were 0.007 mg/m3 and 0.550 mg/m2/30d, respectively. In the territory investigated, the total human uptake of cadmium supplied by vegetables, fruit, potatoes, drinking water and air is 3.3-32.6 microgram/d. The following cadmium levels were found in human organ samples obtained at necropsy: right and left renal cortex, 33.99 and 35.98 p.p.m., respectively; liver, 3.14 p.p.m.; lungs, 0.63 p.p.m.; pancreas, 1.47 p.p.m.; brain stem, 0.16 p.p.m.

Brain Stem↗