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Biomedical subjects

K Vetter

Publications and source records attributed to K Vetter.

At least 73 records · Page 4Linked to original sources
PubMed1987

Conservative long-term treatment of chronic renal failure with keto acid and amino acid supplementation.

In a group of 119 patients with advanced chronic renal failure (serum creatinine level 733 +/- 186 mumol/l) the effect of a low-protein diet supplemented with essential amino acids (EAA) or their keto analogues (KA) on uremic metabolism and rehabilitation status was investigated. The protein intake amounted to 0.4 g/kg B.W./day, the phosphorus intake 0.4-0.6 g/day and the energy supply 120-150 kJ/kg B. W./day. In 51 patients there was a substitution with EAA and in 68 patients with their KA. The mean duration of dietary treatment in this study was 19 months (6-64 months). During this time, the serum creatinine increased from 733 +/- 186 to 1,220 +/- 256 mumol/l, whereas the urea nitrogen values remained relatively constant at between 26 and 30 mmol/l. There were no signs of protein malnutrition (nitrogen balance, serum transferrin and serum protein were normal). The hemoglobin concentration remained at greater than 5 mmol/l with creatinine levels of 1,220 +/- 256 mumol/l. During the substitution with KA, there was a significantly greater decrease in serum phosphate (p less than 0.05) and parathyroid hormone (PTH) (p less than 0.01) as compared with the uremics given EAA. In addition, we found a significant increase in testosterone (p less than 0.01) in patients supplemented with KA. Despite advanced chronic renal failure there was a good degree of rehabilitation (full-time work: 21%; part-time work: 66.4%). It can be concluded that a low-protein diet supplemented with EAA or KA can improve the uremic metabolism, rehabilitation status and safely postpone the start of maintenance dialysis.

Adolescent↗
PubMed1987

Influence of keto acid (KA) treatment on renal osteodystrophy.

A marked improvement of renal osteodystrophy was achieved after a combined treatment with keto acids and vitamin D in patients with chronic renal failure. Results were checked by histological investigations. The biochemical background of the successful treatment was analysed. A regression of hyperparathyroidism and improvement in vitamin D status are the cause of this phenomenon.

Amino Acids↗
PubMed1987

[Assessment of risk status using nutrition diagnostic studies in surgical patients. 1. Determination of preoperative risk status in patients with stomach cancer].

The diagnosis of the nutritional state is an essential component in determining the risk in patients with carcinoma of the gastrointestinal tract. Based on the results of multivariate, statistical analyses of numerous biochemical, anthropometric and immunologic parameters in 63 patients with gastric carcinoma, we can now simplify the determination of the nutritional state considerably. With the help of cluster analysis and together with clinical aspects, the nutritional state can be divided into 2 groups ('normal' and 'disturbed'), in contrast to the former classification ('normal' and several degrees of disturbed). Using discrimination analysis, a combination of parameters was found which allows a sufficiently good classification of subjects into either the 'normal' group or the 'disturbed' group, and in this way characterizes the nutritional state. Classification of the patients is accurate in 97% of the cases. 6 practically relevant parameters were determined with the discrimination analysis: serum albumin, serum transferrin, hemoglobin, upper arm circumference, triceps skin fold thickness, and the intracutaneous skin test quotient. The nutritional quotient, EQ2, can be determined from these values (in comparison to the nutritional quotient, EQ1, which is based on the 33 point evaluation scale), thus enabling a quantification of the nutritional state. The use of only individual parameters yields major differences from the results obtained with 6 parameters. However, a relation between the nutritional state and the existing immuno-competence can be suspected when the results - especially of the skin test reactions - are in agreement with the results of the lymphocyte transformation. The test results of cell-mediated immunity in particular represent the extent of a reduced immunological reaction as opposed to the results of humoral immunity. Inclusion of less complex immunological investigation procedures must be reserved for future studies. The determination of daily urea production (urea production rate; dependent on protein supply) can be implemented as a practically relevant and reliable supplemental test for the evaluation of the existing metabolic state.

Anthropometry↗
PubMed1985

Acute polyhydramnios complicating twin pregnancies.

Acute polyhydramnios in the second trimester is a typical complication in monozygous twin pregnancies. It is caused by a feto-fetal transfusion with anemia on the donor and polycythemia on the recipient twin. Contrary to the chronic hydramnios, there is no increase in malformations. In view of the high mortality rate (100%, according to most authors), the clinical management has to be reconsidered. During the years 1979 to 1983, 10 cases of acute polyhydramnios have been observed at the University Hospital in Zurich. This corresponds to an incidence of 9% in our twin population. All cases investigated were MZ twin pregnancies. With the exception of one patient, who underwent an abortion, all women were hospitalized, had bed rest and received recurrent removals of amniotic fluid and prophylactic tocolysis. The mean gestational age at the time of diagnosis was 23 4/7 weeks and at delivery 30 3/7 weeks. In two cases--one of which is presented in detail--with an unintentional puncture of a placental vessel, the recurrence of the hydramnios did not appear. Eight of 18 newborns survived. No malformations were found. Bed rest, tocolysis and recurrent amniocenteses seem to have a positive influence on the prolongation and outcome of the gestation in acute polyhydramnios.

Acute Disease↗
PubMed1985

Influence of phosphate restriction, keto-acids and vitamin D on the progression of chronic renal failure.

Progression of renal failure was investigated in a prospective follow-up study of 60 patients with mild and 100 patients with advanced renal failure. Phosphate restriction in mild and protein restriction in advanced renal failure can delay the progression rate of patients with chronic renal insufficiency. Simultaneous administration of Vitamin D does not effect the progression. Administration of keto-acids to the low protein diet has a strong delaying effect on the progression rate.

Dietary Proteins↗
PubMed1984

[The nutritional status in malabsorption syndrome following gastrointestinal operations].

The nutritional status which includes selected biochemical, anthropometric and immunologic parameters was determined in 36 patients with malabsorption syndromes following gastrointestinal operations. The examinations revealed: Postoperative malabsorption syndromes often lead to considerable nutritional disturbances which cannot be sufficiently estimated by the sole determination of body mass. The nutritional status is a precious tool in judging deficiency symptoms, in instituting a targeted alimentary or substitutive therapy,and in evaluating the therapeutic accomplishment. Optimal long-time alimentary or substitutive therapy permits to achieve and maintain a good or sufficient nutritional status in patients with malabsorption syndromes even if the syndromes are due to extended gastrointestinal operations.

Adult↗
PubMed1984

[Controlling renal osteopathy with keto acids].

Starting from the results of former investigations the influence of the long-term treatment with the KA of the essential amino acids on the renal osteopathy is investigated. For this purpose we compared 27 patients with renal insufficiency (serum creatinine 981 +/- 354 mumol/l), who besides vitamin D had been treated with KA for at least 12 months, to a group of 50 patients (serum creatinine 778 +/- 273 mumol/l), who had received vitamin D over 19 +/- 9 months, and to a control group of 27 patients (serum creatinine 928 +/- mumol/l) without an adequate conservative therapy. While the control group showed the typical constellation in advanced renal insufficiency with hypocalcaemia, hyperphosphataemia, clearly increased PTH levels, clearly increased CT values and normal 25-OH-D concentrations, during the diettherapy and the vitamin D substitution a significant increase of the serum levels of calcium, 25-OH-D and CT as well as a significant decrease of the PTH and the anorganic phosphate in the serum developed. Under the combination therapy with KA and vitamin D despite the reduction of the phosphate binders another significant decrease of the PTH and the anorganic phosphate was observed. The mineral content of the bones was within the normal in the two therapy groups. The percentage of the normal histological findings of the bones was with 40.7% highest despite the advanced renal insufficiency in the simultaneous substitution with KA. While in the vitamin D group during the control biopsy after 12 months in 20.5% of the cases an improvement of the histological findings developed, this effect occurred under additional KA-therapy in 51.9% of the cases. The results allow the conclusion that by means of the long-term treatment with KA a favourable influence on the renal osteopathy develops.

Adult↗
PubMed1983

[Importance of the modern hospital diet in medical practice].

Hospital diet is an essential part of modern therapy in all medical departments. It comprises both the so-called normal diets which are prepared according to modern nutritional knowledge, dietetic foods and the various forms of artificial nutrition (nutrient-defined and chemically defined diets, parenteral and combined nutrition, i.e. enteral and parenteral nutrition). The integration of nutritional therapeutic problems into the treatment of patients requires optimal scientific and practical forms of organisation of nutrition in the clinic. For that purpose, cooperation of clinical, technical, economic and pedagogic divisions is of prime importance. The organisation of patient nutrition in the St. Georg District Hospital in Leipzig is described as a feasible model.

Deficiency Diseases↗
PubMed1983

Influence of keto acids on serum parathyroid hormone levels in patients with chronic renal failure.

The metabolic effects of short-term and long-term treatment by keto acids were examined in 46 patients with chronic renal failure. Long-term as well as short-term administration to chronic uremics resulted in a significant reduction of serum PTH and inorganic phosphate levels while serum concentrations of serum calcium, 25-OH-D and calcitonin were not influenced. The results presented in this paper allow the conclusion that keto acid treatment of patients with chronic renal failure may be helpful in the control of abnormal calcium-phosphate metabolism and secondary hyperparathyroidism.

Adult↗
PubMed1982

[Influence of protein content on total CSF protein (author's transl)].

The influence of the protein content of nutrition on the total protein of the cerebrospinal fluid was examined in 24 neurological patients showing neither inflammatory diseases nor diseases where a rise of the total protein in the CSF can be expected. 14 patients were at random separated into two groups and received either a high protein or a low protein isocaloric diet for seven days. The then observed changes in the total protein content of the CSF between both groups were significant. In ten other patients whose total protein content of the first lumbal puncture was beneath 35 or above 55 mg% the observed changes after high protein or low protein diet were more pronounced, the farther a value was situated from the normal range. It is asked if the "normal range" has not to be defined depending on the protein uptake with nutrition.

Blood Proteins↗
PubMed1982

[HCG and SP-1 in normal pregnancy and in high-risk early pregnancy].

For the prognosis in early pregnancies associated with vaginal bleeding ultra-sonography and bio-chemical methods are prominent today. In a retrospective study of 90 determinations of both chorionic gonadotrophin (HCG) and SP-1 (pregnancy specific protein-1, TGB PS beta G) the prognostic value of these two glyco-proteins synthesized in the trophoblast were compared. Both parameters were reliable for the prognosis of threatened abortion, correlated well with each other and showed excellent statistical results regarding sensitivity, specificity and prognostic value regarding abortion or a chance for continuation of the pregnancy. Both were very efficient. These results show that HCG and SP-1 are equally well suited for the serial evaluation of trophoblast function in early pregnancy. Their value compared to ultra-sonography needs further studies.

Abortion, Threatened↗