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Biomedical subjects

T Symreng

Publications and source records attributed to T Symreng.

31 records · Page 2Linked to original sources
PubMed1985

Severe anorexia nervosa treated with total parenteral nutrition. Clinical course and influence on clinical chemical analyses.

Severe anorexia nervosa in which psychiatric treatment has failed is a life-threatening condition since the degree of emaciation can be profound. Nine young women with a weight loss of 25-50% of their habitual weights were given total parenteral nutrition (TPN) over 3-8 weeks through a tunneled central venous silicone catheter. They initially received a mean of 55 kcal/kg body weight/24 hours increasing to 65-70 kcal/kg body weight during the first week. The initial bradycardia and hypotension were normalized and body weight increased with a mean of 2.5 kg/week. All patients showed a general somato-psychic improvement after two weeks of TPN. The electrolyte disturbances seen at the beginning were normalized during the first weeks of treatment and the previously reported life-threatening electrolyte disturbances and dehydration in connection with TPN treatment were not seen. The only adverse effect registered was a rise in liver enzymes in two patients who were given greater than 80 kcal/kg and day. With a reduction of the caloric supply these changes normalized, and TPN could be continued. After 3-8 weeks the oral intake had normalized and TPN was discontinued. This study confirms that TPN can be used successfully and with minimal risk in severe anorexia nervosa until the patients have normalized their oral intake.

Adolescent↗
PubMed1983

Delayed hypersensitivity. A critical evaluation of five recall antigens in a large reference population.

The reactivity to five recall antigens, candida, mumps, PPD, varidase and trichophyton and the corresponding diluents was tested in 840 healthy persons aged between 17 and 101 years. Candida antigen was tested in a lower (l) and a higher (h) dose. The size of reactions did not follow a Gaussian distribution and we therefore used the 10th and 5th percentiles instead of standard deviation to define the limits between positive, weak and negative reactions. The number of positive reactions to each of candida-h, mumps, PPD and varidase was between 80 and 95 per cent in patients less than 60 years of age and above this age it varied between 0 and 85 per cent. The number of positive reactions to candida-l and trichophytin was low in all ages. The reactivity was regarded as normal if there was a positive reaction i.e.sum of right angle diameters >10 mm to atl east one antigen, relatively anergic if there was only a weak reaction (7-9 mm) and anergic if there was a negative reaction (0-6 mm) to all antigens. A normal reaction was found in 100 per cent of subjects up to 60 years of age, and in 95 per cent up to 30 years. Among those with normal reactivity, positive results were found with candida-h alone in between 67-93 per cent, candida-h + mumps between 92-100 per cent and candida + mumps + PPD in 100 per cent irrespective of age.

Journal Article↗
PubMed1983

Nutritional assessment reflects muscle energy metabolism in gastric carcinoma.

Preoperative nutritional status and muscle energy metabolism were studied in 26 patients with gastric carcinoma. Fat stores were reduced in 30% and visceral proteins in 25% to 90% of the patients. According to the nutritional assessment, the patients were divided into well-nourished (group I, n = 8) with no or minor signs of malnutrition and malnourished (group II, n = 13) with signs of pronounced malnutrition. Group I had normal content of muscle energy metabolites despite their malignant disease. In group II, adenine nucleotides (p less than 0.001), phosphorylcreatine (p less than 0.01), creatine (p less than 0.05) and also glycogen (p less than 0.01) were markedly decreased. Weight loss, albumin, and fibronectin levels correlated significantly with adenosine-triphosphate, total adenine nucleotides, and glycogen levels. The most malnourished patients also had the poorest energy metabolite status in the muscle. These findings revive the interest in nutritional assessment.

Aged↗
PubMed1983

Delayed hypersensitivity response and vitamin D deficiency.

The relationship between delayed hypersensitivity and serum levels of 25-hydroxyvitamin D were examined in sixty-three elderly people. After intracutaneous injection of five recall antigens (Candida, mumps, PPD, tricophyton and varidase) nineteen subjects showed no response (anergy), seven showed only a weak reaction (relative anergy), and thirty-seven a normal reaction. In the anergic group mean serum level of 25-hydroxyvitamin D was significantly lower than in the group with normal immunoreactivity. Five subjects with anergy and serum 25-hydroxyvitamin D below 20 nmol/l were treated with oral vitamin D or UV irradiation for two to three months, after which both the serum 25-hydroxyvitamin D levels and the delayed hypersensitivity were normalized. In a non-treated group anergy persisted in seven out of nine patients in a second skin test. We conclude that anergy in the delayed hypersensitivity skin test in humans may in some cases be due to vitamin D deficiency.

25-Hydroxyvitamin D 2↗
PubMed1983

Nutritional assessment and clinical course in 112 elective surgical patients.

Recent Swedish reference values in anthropometry and delayed hypersensitivity (DH) were applied in the nutritional assessment of 112 surgical patients. The presence of three or more subnormal variables indicating malnutrition was found in 28% of all patients, and in 52% of those with malignant disease. The anthropometric variables revealed deficits in fat stores and muscle in 26 and 6%, respectively. Plasma protein determinations indicated malnutrition in 6-49%. DH skin testing revealed a subnormal response in 17% of the patients. Ten of the 79 operated patients had postoperative complications. Malnutrition was found preoperatively in six of these. The malnourished patients had a 5.5 times higher complication rate compared to the well-nourished (p less than 0.01). Subnormal values in albumin, prealbumin or DH were associated with a statistically significantly increased complication rate. Regression analysis showed correlations between the anthropometric measurements and plasma protein levels. Furthermore, DH correlated with triceps skin fold, albumin, prealbumin and cholinesterase.

Adolescent↗
PubMed1982

Arm anthropometry in a large reference population and in surgical patients.

Triceps skinfold (TSF) and midarm circumference (MAC) were measured and the arm muscle circumference (AMC) calculated in 1860 healthy persons aged between 20 and 101 years and because the distribution of our findings was not Gaussian we have used the 5th and 10th percentiles instead of standard deviation to define limits between severe and moderate malnutrition and between moderate malnutrition and normal. One-way variance analysis showed significant increases in TSF in women from the 3rd (mean 18.3 mm) to the 6th (mean 23.6 mm) decades (p<0.05 - 0.001). No variation was seen in the 6th and 7th decades but thereafter decreases occurred to the 10th (mean 14.4 mm) decade (p<0.05 - 0.001). In men, TSF showed no variation from the 3rd (mean 10.8 mm) to the 9th (mean 10.6 mm) decades but in the 10th (mean 9.4 mm) decade it decreased significantly (p<0.05). In women, AMC increased from the 3rd (mean 21.1 cm) to the 6th (mean 22.1 cm) decades (p<0.05 - 0.001). No variation was seen from the 6th to 8th decades, but thereafter decreases occurred to the 10th (mean 20.2 cm) decade (p<0.05 - 0.001). In men no variation was seen in AMC from the 3rd (mean 26.2 cm) to the 7th (mean 25.9 cm) decades, but decreases were shown to the 10th (mean 23.0 cm) decade (p<0.001). Using these values in 112 surgical patients, 26 per cent showed signs of malnutrition in their fat stores and 6 per cent in muscle. The wide variation in anthropometric measurements between different age groups precludes the use of a mean reference value covering all ages in the assessment of malnutrition.

Journal Article↗
PubMed1982

Extradural and parenteral morphine: kinetics and effects in postoperative pain. A controlled clinical study.

In a controlled clinical study of 20 patients undergoing arthrotomy a single dose of morphine 0.05 mg kg-1 administered extradurally resulted in more pronounced and prolonged pain relief than morphine 0.1 mg kg-1 i.m. in the period immediately after operation. This difference was significant between 2 and 11 h after morphine administration. The maximum analgesic effect for nine patients in the extradural group was obtained about 2 h after injection. Two of 10 in the extradural group experienced urinary retention. Other side-effects were mild for both groups. Plasma concentrations of morphine were measured in five patients in each group. Four hours after administration, morphine was not detectable in plasma in any of the extradural group and in two of the i.m. group. Our study gives further support for the theory that extradural morphine acts on the spinal cord.

Adult↗
PubMed1981

Physiological cortisol substitution of long-term steroid-treated patients undergoing major surgery.

In 22 patients undergoing elective surgery, adrenal function was assessed before and on the day of surgery. Patients receiving corticosteroid therapy but with a normal cortisol response to a corticotropin stimulation test (group II, n = 8) were not given hydrocortisone on the day of operation. Their cortisol concentration increased in a manner similar to patients (group I, n = 8) who had never had corticosteroid treatment. The plasma cortisol concentrations in these two groups were less than in subjects (group III), n = 6) with an impaired cortisol response to corticotropin stimulation, who were given hydrocortisone 25 mg at the induction of anaesthesia followed by a continuous infusion of hydrocortisone 100 mg during the next 24 h. There were no clinical signs of circulatory insufficiency in any group. The low-dose hydrocortisone therapy regimen is sufficient for substitution of adrenal function during surgery and in the early postoperative phase. It could lead to mild oversubstitution in patients with impaired adrenal insufficiency undergoing major surgery.

Adrenal Cortex Hormones↗
PubMedDate not supplied

The effect of respiratory alkalosis on oxygen consumption in anesthetized patients.

STUDY OBJECTIVE: To investigate whether hyperventilation significantly altered oxygen consumption in anesthetized and paralyzed patients undergoing surgery. DESIGN: Open crossover trial with 1 hour of hyperventilation preceded and followed by 1 hour of normoventilation. SETTING: University medical center. PATIENTS: Eight patients (five men and three women) undergoing lengthy orthopedic surgery with general anesthesia and muscle paralysis. INTERVENTIONS: After baseline normoventilation for 1 hour (Period 1), the anesthetized patients were hyperventilated to an arterial carbon dioxide tension (PaCO2) of 20 to 25 mmHg for 1 hour (Period 2). Patients then experienced another hour of normoventilation (Period 3). MEASUREMENTS AND MAIN RESULTS: Hemodynamic variables, electrocardiography, temperature, end-tidal partial pressure of CO2 (PETCO2), oxygen consumption (VO2), carbon dioxide production, and minute ventilation were continuously followed throughout the study, and arterial blood gases were drawn at the beginning and end of each study period. During the period of hyperventilation, pH was significantly higher and P.ETCO2 and PaCO2 significantly lower compared with the periods of normoventilation. VO2 was significantly increased during hyperventilation compared with the periods of normoventilation. Hemodynamic variables and temperature were similar in the three study periods. CONCLUSIONS: In anesthetized paralyzed patients, there is an increase in whole-body VO2 with hypocapnic alkalosis.

Adult↗
PubMedDate not supplied

Continuous enteral feeding and short fasting periods enhance perioperative nutrition in patients with burns.

Both retrospective and prospective analyses of the effects of various fasting regimens were carried out on the achievement of calculated caloric needs of patients with severe burns. The records of patients who received enteral feedings while undergoing burn debridements were divided into three groups and retrospectively analyzed to determine the effect that duration of fasting had an achievement of caloric needs and on the risks of aspiration. Patients in two other groups were prospectively studied to determine the safety and efficacy of stopping continuous enteral feedings 1 and 4 hours before surgery, respectively. Techniques of airway management and anesthetic induction were left to the discretion of the attending anesthesiologist. In the retrospective analysis, patients in group I, who fasted for 2 hours achieved 28% of their calculated 24-hour caloric goals compared with 11% in those who fasted for 2 to 8 hours (group II) and 6% in those who fasted for more than 8 hours (group III) before surgery (p less than 0.001). In the prospective portion of the study, patients who fasted for 1 hour before anesthesia was induced achieved 30% of their caloric needs, whereas those who fasted for 4 hours achieved 15% of their target nutritional needs (p = 0.0001). No patient had evidence of pulmonary aspiration. We conclude that controlled enteral feedings and shortened preoperative fasting periods can safely enhance nutritional support in patients with burns.

Adult↗
PubMedDate not supplied

Rapid determination of cold insoluble globulin by laser nephelometry. Application in patients receiving preoperative total parenteral nutrition.

A simple and rapid method for determining plasma fibronectin or cold insoluble globulin (CIG) based on immunochemical precipitation and laser nephelometry is described. The coefficient of variation within the series was 4.2% and between the series 9.1%. The mean value for 37 control subjects was 100.1% +/- 20.6 (SD). Nineteen patients with gastrointestinal carcinoma or Crohn's disease were investigated on admission. The mean value of their plasma CIG was 104.7 +/- 26.9 (SD), which was not statistically different from the control subjects. Twelve of the patients received total parenteral nutrition (TPN) during the two preoperative weeks. The concentration of CIG was significantly increased after one and two weeks of TPN compared to the initial value. Six out of seven patients that postoperatively showed signs of infection had CIG values below 90% on admission. Of several other plasma proteins determined on admission, only a statistically significantly negative relationship to transferrin was found. CIG did not significantly relate either to the acute phase reactants, haptoglobin and orosomucoid, or to visceral proteins albumin, choline esterase or prealbumin.

Adult↗
PubMedDate not supplied

Influence of total parenteral nutrition on plasma fibronectin in malnourished subjects with or without inflammatory response.

Plasma fibronectin, which is an alpha 2-glycoprotein of importance for the immunodefence, has been reported to decrease after starvation and in severely ill patients with cancer. To evaluate the usefulness of fibronectin as an indicator of nutritional repletion, 18 patients with gastrointestinal disorders were studied over a 2-wk period of total parenteral nutrition (TPN). According to nutritional assessment on admission the patients were divided into well nourished (n = 6) and malnourished (n = 12). For comparison nine patients with anorexia nervosa were also studied over a 3-wk period of TPN. Before and after TPN fibronectin, albumin, prealbumin, transferrin, and two acute-phase reactants, haptoglobin and orosomucoid were measured in plasma. The majority of the malnourished patients had an inflammatory reaction in contrast to only a few of the well-nourished and anorexia nervosa patients. Of the proteins measured, only fibronectin rose significantly in the malnourished patients (malnourished and anorexia nervosa), but not in the well nourished patients during TPN. Our results may indicate the usefulness of fibronectin as an indicator of short-term TPN in malnourished subjects, irrespective of the presence or absence of inflammatory response.

Adolescent↗