Search PubMed⌕ Search

Biomedical subjects

P Sporn

Publications and source records attributed to P Sporn.

At least 55 records · Page 3Linked to original sources
PubMed1986

[Acute renal failure in abdominal infection. Comparison of hemodialysis and continuous arteriovenous hemofiltration].

58 patients with peritonitis and acute renal failure (ARF) were treated either by haemodialysis (HD, n = 22), continuous arteriovenous haemofiltration (CAVH, n = 9), or continuous pump-driven haemofiltration (CPDHF, n = 27). In contrast to HD, which led to severe hypotension in 31.9% of procedures and to cardiac arrest in 3 cases, CPDHF caused neither haemodynamic nor metabolic alterations. Control of uraemia was most effective in the CPDHF group, too. Mean daily BUN and creatinine values fell significantly (p less than 0.005) and remained at 60 mg % and 2.0 mg %, respectively, whereas during HD no significant changes were found. During CAVH serum creatinine showed an insignificant decline, whereas BUN even increased. Despite higher costs CPDHF seems to be a promising alternative to HD or CAVH for treatment of ARF in septic patients, as mortality was lower in the CPDHF group and recovery of renal function occurred in 48.2%, whereas during HD only 27.3% recovered from ARF.

Acute Kidney Injury↗
PubMed1985

[Regional results of human liver transplantation in Vienna].

21 cases of transplantation of the liver are analysed for indication, anaesthesia, operative management, anhepatic period, immunological therapy and specific post-operative problems (jaundice and rejection episodes). Causes of death are noted and prediction of survival gives a rate of 55%/1st year in the 17 patients operated on since 1982 under a standardised management schedule. The transplantation programme in Vienna provides routine treatment for otherwise untreatable primary (57% cases) and secondary metastatic (14%) tumours of the liver, and, in the second place, for end-stage hepatic cirrhosis (14%) and certain rare liver diseases (14%).

Adult↗
PubMed1985

[Problems of blood replacement in liver transplantation].

Liver transplantation often is accompanied with massive bleeding-blood losses up to 125 I have been reported. A survey of 21 transplantations describes the management for substitution of blood components. After an initial series of 18 patients including 4 cases with blood losses exceeding 100 units of blood, an attempt was made to optimize coagulation in 5 cases with NT-values below 40% by preoperative plasmapheresis. Platelet transfusion was performed in all cases with platelet values below 120 000. These measures led to a significant reduction in blood units substituted during the last 9 transplantations.

Adult↗
PubMed1985

[Pathogenic flora in the gastric juice and bronchial secretion of long-term ventilated intensive-care patients].

Nosocomial pneumonia is a major risk for long term ventilated ICU patients. The infection route may be hematogenic or via inhalation or aspiration of microorganisms. The source of aspiration is the oropharynx. This prospective study intended to study the role of the stomach as a reservoir of bacteria in ICU patients treated with cimetidine. Gastric juice and bronchial secretion from 34 patients ventilated for more than 4 days were examined bacteriologically. 72,8% of the gastric (G) and 79,1% of the bronchial aspirates (B) revealed significant bacterial growth (more than 10(4) microorganism/ml). Pseudomonas, Klebsiella, and Candida spp. were found in 56,7% (B) and 51,8% (G) of the positive cultures as an effect of selection caused by antibiotics. Organisms of intestinal origin were found in 17,8% (B) und 15,5% (G), respectively. In 32,5%, identical organisms or patterns of organisms were found in the gastric and bronchial aspirates. 7 of the 34 patients (20,6%) developed pneumonia; in 6 of these 7 cases, the same organisms could be identified at the same and/or at the last examination before developing pneumonia in gastric content and bronchial secretion. The pH-value of the sterile aspirates was lower than of the colonized aspirates (5,39 vs 5,99). During enteral nutrition, 31,4% of the aspirates were sterile, whereas during parenteral nutrition only 24,3% of the gastric aspirates were sterile. Therefore, enteral nutrition should be started as soon as possible, the pH-value should be checked frequently and should not exceed 4 in order to reduce bacterial overgrowth in the stomach. A further consequence is to use as few antibiotics as possible.

Adult↗
PubMed1985

Amino acid concentrations in plasma and skeletal muscle of patients with acute hemorrhagic necrotizing pancreatitis.

We measured amino acid concentrations in plasma and skeletal muscle of three groups of patients with acute hemorrhagic pancreatitis: (a) patients without secondary organ lesions, (b) patients also suffering from kidney damage, and (c) patients in whom the pancreatitis was accompanied by sepsis and multiple organ failure. In all three groups, especially the third group, the amino acid concentrations in both plasma and muscle were below normal. Glutamine was only 14% of normal in muscle tissue of the third group. Onset of renal insufficiency was indicated by increasing values for 3-methylhistidine and cystathionine; multiple organ failure, by increased concentrations of methionine and phenylalanine in plasma. The low amino acid concentrations of patients with acute pancreatitis can be explained as a combined effect of semistarvation and hypercatabolism. Changes in the plasma concentrations of amino acids did not reflect necessarily the concentrations in muscle tissue.

Acute Disease↗
PubMed1985

[Monitoring kidney function in abdominal infection].

In ICU patients suffering from abdominal sepsis acute renal failure (ARF) is a common (50% incidence) and often lethal (more than 80% mortality) complication. Continuous monitoring of renal function is necessary for both adequate fluid replacement and early detection of ARF. Using a programmable handheld computer the following parameters are calculated at least daily: creatinine, osmolal and free water clearance, fractional excretion of sodium and potassium and non-saline loss. The clearance values are corrected to 1.73 m2 body surface area. Free water clearance proved to be a particularly valuable guide for fluid therapy as well as for early diagnosis of ARF. In all septic patients renal function is impaired to some degree, since despite increased cardiac output creatinine clearance is only normal or even decreased. More than 50% of our patients with abdominal sepsis develop ARF, resulting in a dramatic increase in mortality. Goal of renal monitoring in sepsis is to detect ARF as early as possible and to differentiate between extrarenal and septic origin to enable immediate surgical treatment.

Acute Kidney Injury↗
PubMed1985

[Continuous hemofiltration in peritonitis].

During a period of 3 years 27 patients in acute renal failure (ARF) due to peritonitis underwent pump driven continuous hemofiltration (PDHF). PDHF caused neither hemodynamic nor metabolic disturbances, which in contrary are frequently seen during intermittent hemodialysis treatment in septic patients. BUN and creatinine levels fell significantly (p less than 0.001) and remained at 60 mg% and 2.0 mg%, respectively (mean values). Severe coagulation disorders occurred in 5 patients; in 2 patients PDHF was continued under protamine administration into the venous line, in 3 patients PDHF was stopped for 24 hours and than started again. Bleeding stopped in all cases, therefore surgery was not necessary. Other major complications of PDHF were not observed. Kidney function recovered in 44.4% of patients, and mortality was 70.4%. This is clearly lower than in abdominal septic patients under intermittent hemodialysis. Despite much higher costs (2.5 times the costs of hemodialysis treatment per day) PDHF seems to be a promising alternative in the treatment of ARF complicating septic multiple organ failure.

Acute Kidney Injury↗
PubMed1985

[Evaluation of the thermal technic for the quantitative measurement of extravascular lung water].

To evaluate the accuracy of the method, sequential measurements (n = 159) of extravascular lung water (EVLW) using the thermo-dye double-indicator dilution technique were performed in 22 critically surgical ill patients. Radiographic grading of lung water content served as clinical standard. Normal mean EVLW defined radiographically without evidence of pulmonary edema was 4.8 +/- 1.1 ml/kg. Early interstitial fluid accumulation was quite accurately detected with 6.9 +/- 2.1 ml/kg EVLW (p less than 0.001 vs normal lung water content). The mean EVLW present with definitive interstitial and alveolar edema was 11.5 +/- 3.8 ml/kg and 19.1 +/- 4.5 ml/kg, respectively. Despite some objections to the method (diffusion limitation of the thermal indicator, uneven regional lung perfusion), this technique for measuring EVLW reliably assesses the degree of pulmonary edema. Even when properly performed, chest roentgenograms only confirm gross changes in the lung water content.

Adolescent↗
PubMed1984

[Indications for tracheotomy in long-term ventilated critically ill patients].

In order to evaluate the frequency and indication of tracheotomy in long-term ventilated critically ill patients we analysed retrospectively patients requiring artificial ventilation for periods of more than 7 days. During 1974-75 30 out of 55 of these patients were tracheotomised. In accordance with common practice, early tracheotomy (14 patients) was performed when ventilatory support was expected to exceed 8 to 10 days. In another 16 cases, the same limits were applicable for terminating prolonged tracheal intubation in favour of tracheotomy. In contrast, during the period 1980-81 tracheotomy had been indicated in 8 out of 94 patients. Early tracheotomy was limited to four patients with severe facial injuries accompanied by acute lung failure. The decision to perform tracheotomy or to continue prolonged tracheal intubation was based on definite findings during direct laryngoscopy and fibre bronchoscopy examination of the airways. No late laryngeal sequelae after prolonged tracheal intubation were observed. The risks have been reduced by the use of recently introduced tube materials. Prolonged tracheal intubation has become a safe alternative to tracheotomy.

Critical Care↗
PubMed1983

The use of the Haemoccult test for detection of blood in gastric aspirates.

The guaiac test has recently been used as a determinant of gastric mucosal bleeding in trials comparing different therapeutic regimens for the prevention of gastric stress ulceration. A prospective study, evaluating the efficacy of cimetidine in controlling the gastric pH in 44 patients in our intensive care unit, demonstrated a significant direct correlation between the pH of the gastric aspirate and the Haemoccult test result. The percentage of positive test results decreased progressively with declining pH. Since this seemed to contradict all modern concepts of gastric mucosal damage, we investigated further the pH-dependent sensitivity in vitro. Using different test solutions (NaCl, gastric juice, duodenal juice, and bile) we demonstrated a strong pH-dependent decrease of sensitivity to detect blood below a pH of 4. These results led to the conclusion that the guaiac test is not a valid measure of gastric mucosal bleeding unless used on buffered gastric aspirates.

Cimetidine↗
PubMed1983

Nonoliguric acute renal failure after captopril therapy.

In a patient with severe renovascular hypertension, nonoliguric acute renal failure developed after she received captopril treatment. We believe this to be a previously unreported complication. Urine volume ranged from 1,640 to 2,260 mL/24 hr, and serum creatinine level rose from 2.3 to 8.3 mg/dL. There was no evidence of renal hypoperfusion or interstitial nephritis. Acute renal failure most likely was secondary to the nephrotoxic effect of captopril on chronically hypoperfused kidneys. Renal function improved rapidly after withdrawal of the drug therapy.

Acute Kidney Injury↗
PubMed1982

Metabolic disorders in severe abdominal sepsis: glutamine deficiency in skeletal muscle.

The metabolic profiles of 14 patients with prolonged abdominal sepsis were analysed on the second day after laparotomy. The profiles of survivors were compared with those of non-survivors who died one to five days after the time of evaluation due to uncontrollable multiple organ failure. In the non-surviving patients plasma glucose and glucagon levels were significantly higher than in surviving patients. The plasma concentrations of phosphoserine, cysteine, valine, phenylalanine, and 3-methylhistidine were found to be significantly increased in non-survivors and their muscle tissue showed significantly decreased concentrations of glutamine, proline and lysine with increases in valine and leucine. A correct classification of non-survivors and survivors could be obtained from the plasma and muscle amino acid concentrations, the highest discriminant power being from muscle glutamine. In severe sepsis metabolic changes correlate with the outcome of the patients, and amino acid metabolism seems to be characterised by low concentrations of muscle glutamine and high levels of the branched chain amino acids possibly indicating an inhibited intracellular glutamine formation in muscle tissue.

Journal Article↗
PubMed1982

[Extracorporeal liver perfusion in the treatment of hepatic coma].

Four patients with fulminant hepatic failure had extracorporal hemoperfusion. In selecting the patients, the following criteria were applied: Potential reversibility of the liver disease, prothrombin time under 10%, neurological coma stage III-IV. In total 11 treatments (9 treatments using baboon and 2 treatments using human livers) were performed lasting from 3 to 60 hours. One patient improved immediately after perfusion. 3 patients died; at post mortem severe oedema of the brain and acute yellow atrophy of the liver without tendency to regeneration was observed in these patients.

Adult↗
PubMed1982

[Perforation of the trachea. A lethal complication following tracheostomy prolonged ventilation caused by faulty material (author's transl)].

Among 404 tracheostomies performed for long term ventilation within the last 15 years the first lethal complication (the overall complication rate being 2,97%) was observed: perforation of the membraneous part of the tracheal wall. The complication is directly related to the substitution of a "high-pressure"-cuff tracheostomy tube by a "low-pressure"-cuff-model. Decubital ulceration by the high pressure cuff, injury caused by the stiff uncoated tip of the low pressure model, and a blow-up mechanism by an excentric gas stream are discussed as eventual causal factors of this complication.

Adult↗