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Biomedical subjects

K Lenz

Publications and source records attributed to K Lenz.

At least 127 records · Page 7Linked to original sources
PubMed1985

[Circulatory behavior of patients with liver insufficiency].

Haemodynamic data were obtained in 26 patients with hepatic failure admitted to the intensive care unit of the First Department of Medicine, Vienna University. There was a significant increase in heart rate (101 vs 78 beats/min) and decreased diastolic pressure (56 vs 71 mm Hg) as compared with healthy persons. The cardiac index was elevated (5.1 vs 3.5 l/m2) and the total peripheral resistance was lowered (621 vs 1130 dyn/sec/cm-5). The systolic blood pressure was within the normal range except in 8 patients whose illness was complicated by sepsis. In those 8 patients the systolic blood pressure (86 vs 128 mm Hg), the diastolic blood pressure (42 vs 61 mm Hg) and the total peripheral resistance (434 vs 764 dyn. sec. cm-5) were all decreased as compared with patients with hepatocellular disease without sepsis. The decreased total peripheral resistance, however, was not associated with a further increase in the heart rate or stroke volume. On the contrary, in these 8 patients the left ventricular performance was lowered. The increase in cardiac output was not associated with an increase in oxygen consumption in patients without sepsis. Oxygen consumption was increased in patients with hepatocellular insufficiency and sepsis (157 ml/m2 vs 123 ml/m2) and this was accompanied by a diminished oxygen extraction rate (16% vs 26% in these 8 patients.

Adult↗
PubMed1985

[Determination of extravascular lung water in critical patients: comparison with radiological, hemodynamic and functional lung findings].

Measurement of extravascular lung water (EVLW) was performed by the thermal-dye technique in 55 critically ill patients. The EVLW values were compared with the corresponding radiographic, hemodynamic and functional pulmonary data. EVLW values revealed a positive correlation with the chest X-ray score (CXR) (r = 0.836; p less than 0.001), mean pulmonary artery pressure (PP) (r = 0.414; p less than 0.01), pulmonary capillary wedge pressure (PCWP) (r = 0.353; p less than 0.01), venous admixture (Qs/Qt) (r = 0.288; p less than 0.05), and alveo-arterial oxygen difference/fraction of inspired oxygen (AaDO2/FiO2) (r = 0.441; p less than 0.001). No correlation was found between EVLW values and colloid-osmotic pressure minus PCWP (COP-PCWP) (r = 0.221). Though different positive correlations between EVLW values and these parameters were found, they cannot replace EVLW measurement. Rather, EVLW measurement provides additional information on the degree of pulmonary edema which is useful in differentiating between cardiac and non-cardiac pulmonary edema and in states of radiologic over- or underestimation of EVLW.

Adult↗
PubMed1985

Enhancement of renal function with ornipressin in a patient with decompensated cirrhosis.

An infusion with Ornipressin (8-ornithin vasopressin) in a patient with decompensated alcoholic liver cirrhosis increased urinary volume from 30 ml/h to 500 ml/h, creatinine clearance from 24 to 65 ml/min, and fractional sodium excretion from 0.86% to 11.1%. Free water clearance decreased from -10.2 ml/h to -26.2 ml/h and noradrenaline plasma concentrations dropped from 2.04 to 1.37 ng/ml. After stopping Ornipressin infusion all values returned to initial concentrations. Possible effects are an increase of renal blood flow secondary to an increase in arterial blood pressure, possibly potentiated by the vasodilatory effect of the fall in noradrenaline and/or angiotensin concentration.

Adult↗
PubMed1985

Methicillin- and gentamicin-resistant Staphylococcus aureus: susceptibility to fosfomycin, cefamandole, N-formimidoyl-thienamycin, clindamycin, fusidic acid and vancomycin.

The in vitro activity of fosfomycin against 90 strains of methicillin- and gentamicin-resistant Staphylococcus aureus was studied in an in vitro microtitre system using Mueller-Hinton broth supplemented with glucose-6-phosphate. In parallel the antistaphylococcal activity of cefamandole, N-formimidoyl-thienamycin, clindamycin, fusidic acid and vancomycin was determined with the same organisms. The following MIC50 (MIC95) values were obtained: fosfomycin 8 (128) mg/l, cefamandole 8 (greater than 64) mg/l, clindamycin 0.25 (16) mg/l, fusidic acid less than 0.25 (less than 0.25) mg/l, vancomycin 1 (2) mg/l and N-formimidoyl-thienamycin 4 (16) mg/l. A high MIC/MBC ratio was noted for cefamandole, in contrast to fosfomycin.

Cefamandole↗
PubMed1985

Post-heparin lipolytic activity in acute renal failure.

Total post-heparin lipolytic activity (PHLA), hepatic triglyceride lipase (HTGL) and protamine inactivated lipoprotein lipase (LPL) and plasma lipoprotein pattern were investigated in 8 patients with acute renal failure (ARF). PHLA was determined at 5, 10, 15, 30, 45 and 60 minutes after heparin administration (100 U/kg b.w.). Maximal PHLA in ARF was 6.12 +/- 1.56 mumol FFA/ml/h at 10 minutes versus 14.62 +/- 4.29 at 45 min in controls (= 42%, p less than 0.001). PHLA was reduced in ARF throughout the study period (p less than 0.001). Maximal HTGL activity (3.06 +/- 0.84 mumol FFA/ml/h) was obtained at 10 min in ARF versus 8.97 +/- 3.11 after 15 min in controls (= 34%, p less than 0.001). HTGL in ARF differed from controls at all points of determination (p less than 0.001). LPL maximum was 3.12 +/- 1.93 mumol FFA/ml/h at 15 min in ARF and 7.65 +/- 3.44 at 45 min in controls (= 40%, p less than 0.001). LPL activity was different from controls at 30, 45 and 60 min (p less than 0.001) but not at 5, 10 and 15 min after heparin injection. Due to a rapid decrease of LPL activity (half maximal activity after 34 min in ARF versus 94 min in controls, p less than 0.05) activity half life of PHLA was diminished in ARF (49 min in ARF versus 112 min in controls, p less than 0.01). Thus both the activity of HTGL and LPL is impaired in ARF. Because of the different activation kinetics of the two PHLA fractions no conclusions concerning maximal enzyme activities can be drawn from single determinations as suggested in previous studies on chronic renal failure.

Acute Kidney Injury↗
PubMed1984

[Circulatory behavior in critically ill patients during hemodialysis].

Haemodynamic data were obtained during haemodialysis on 21 occasions in 7 patients with septicaemia and pancreatitis, and in 5 patients with primary renal failure without septicaemia or pancreatitis. In the former group of patients there was a lowering of the blood pressure 30, 60, 90 and 120 minutes after haemodialysis had been initiated, which was significantly greater than in the later group. The drop in the blood pressure was caused by a decreased cardiac output. The pulmonary wedge pressure dropped in all patients. Peripheral resistance and heart rate did not change during the whole procedure.

Adult↗
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↗
PubMed1983

[Effect of nifedipine on hemodynamics in precapillary pulmonary hypertension at rest and during exertion].

The effect of sublingual nifedipine (20 mg) on haemodynamics at rest and during bicycle ergometry in supine position was assessed in 22 patients with precapillary pulmonary hypertension (obstructive form: n = 17, restrictive form: n = 2, combined obstructive-restrictive: n = 3). At rest nifedipine resulted in an increase of cardiac frequency from 85 to 89/min, during exercise from 109 to 120/min (P less than 0.05). Concomitantly the mean arterial blood pressure decreased significantly both at rest and during exercise. The mean pulmonary arterial pressure showed significant reduction from 42.9 to 36.2 mm Hg (P less than 0.0005) only during exercise. The total body vascular resistance at rest decreased by 21% (P less than 0.005), during exercise by 15% (P less than 0.1). Pulmonary arteriolar resistance at rest decreased by 9%, during maximum loading by 34% from 312 to 215 dyn X s X cm-5 (P less than 0.05). Nifedipine was shown to be a suitable agent for lowering right ventricular afterload in secondary pulmonary hypertension due to chronic lung disease. The beneficial effect at rest depends on the extent of the pulmonary arteriolar resistance and the mean pulmonary arterial pressure. However, during exercise conditions it can be observed in the majority of patients (93%). Due to the variable response haemodynamic assessment is required prior to routine use in order to establish patients with optimal response.

Adult↗
PubMed1983

Effects on blood lipids and body weight in high risk men of a practical exercise program.

The effects of moderate exercise on serum total cholesterol (TC), high density (HDL-C), low density (LDL-C), and very low density (VLDL-C) lipoprotein cholesterol fractions, triglycerides (TG), body weight (BW) and skinfolds (SF) were studied during a 12-week period among 23 sedentary middle-aged men. The results show that regular exercise in men eating a fat-modified diet alters in a favorable direction body fat, weight and lipoprotein fractions. Weight loss with exercise significantly increased HDL-C (P = 0.01), although this increase in HDL-C occurred after a latency period of at least 6 weeks and an average weight loss of at least 4 lbs. The amount of exercise effective in risk factor reduction is within the capacity of most middle-aged men.

Adult↗