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Biomedical subjects

W Graninger

Publications and source records attributed to W Graninger.

At least 217 records · Page 12Linked to original sources
PubMed1990

Energy metabolism in patients with acute and chronic liver disease.

Energy expenditure and substrate oxidation rate for fat, glucose and protein were evaluated by indirect calorimetry in 20 normal individuals, 35 patients with acute hepatitis and 22 patients with biopsy-proven alcoholic cirrhosis in the postabsorptive state. Measurements were done in the resting state after an overnight fast (10 to 12 hr). Oxygen consumption (ml/min/1.73 m2) in normal subjects, in patients with acute hepatitis and in patients with cirrhosis was 206.5 +/- 4.0 (mean +/- S.E.M.), 216.4 +/- 4.7 and 228.8 +/- 7.1 (p less than 0.05 vs. controls), respectively. When related to body surface area (kcal/min/1.73 m2), resting energy expenditure did not differ between normal subjects (0.98 +/- 0.02), patients with acute hepatitis (1.03 +/- 0.02) and cirrhotic patients (1.06 +/- 0.03). However, when related to 24-hr urinary creatinine excretion as an estimate of lean body mass, energy expenditure was increased in cirrhosis (p less than 0.0001). In cirrhosis an inverse association between the severity of liver disease according to Pugh and oxygen consumption and resting energy expenditure was found. In cirrhotic patients the percentages of total calories derived from fat (86% +/- 5%), carbohydrate (2% +/- 4%) and protein (12% +/- 1%) were different from those of normal controls who metabolized 45% +/- 4%, 38% +/- 4%, 17% +/- 1%, respectively. In acute hepatitis no alterations in metabolism could be found apart from a decreased protein oxidation rate. In conclusion no appreciable changes in energy metabolism exist in acute hepatitis. The pattern of fuel use in cirrhosis resembles that in starvation.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1990

Angiotensin converting enzyme activity in children with congenital heart disease.

Serum angiotensin converting enzyme (ACE) activity was determined in 46 children with congenital heart disease with normal and abnormal lung perfusion: (1) congenital heart disease with normal pulmonary blood flow (12 patients); (2) congenital heart disease with increased pulmonary blood flow (18 patients); (3) congenital heart disease with decreased pulmonary blood flow (16 patients). There was no significant difference in serum ACE activity between the three groups. In group 2 serum ACE activity had a tendency to correlate inversely with both mean pulmonary arterial pressure (r = -0.43; P less than or equal to 0.05) and pulmonary vascular resistance (r = -0.48; P = 0.05). No further correlations between serum ACE activity and age, serum electrolytes, creatinine nor other haemodynamic data could be established.

Adolescent↗
PubMed1990

Energy metabolism in acute and chronic renal failure.

Energy metabolism was measured by indirect calorimetry in 86 patients with various forms of renal failure and in 24 control subjects. In patients with acute renal failure with sepsis, oxygen consumption, carbon dioxide production, and resting energy expenditure were increased (P less than 0.05). In other groups with renal failure (acute renal failure without sepsis, chronic renal failure with conservative treatment or hemodialysis, and severe untreated azotemia) these indices were not different from those of control subjects. Urea nitrogen appearance was decreased in patients with chronic renal failure undergoing conservative treatment, in those with severe untreated azotemia, and in hemodialysis patients (P less than 0.05). We conclude that renal failure has no influence on energy expenditure as long as septicemia is absent. Reduced urea nitrogen appearance rates in chronic renal failure are due to a reduced energy and protein intake. Wasting is a consequence of decreased food intake but not of hypermetabolism in chronic renal failure.

Acute Kidney Injury↗
PubMed1990

Immune response in patients during and after Plasmodium falciparum infection.

The kinetics of indicators of lymphocyte activation were determined in non- and semiimmune patients with uncomplicated Plasmodium falciparum infection and in control subjects in Acre, Brazil. Delayed type hypersensitivity (DTH) to seven recall antigens was weakest in nonimmune patients. Both patient groups differed significantly from controls on admission (P less than .001 for both) and improved considerably after clindamycin therapy. Total serum IgG and IgM, but not antimalarial antibodies, were highest in nonimmune patients compared with semiimmune patients and controls during acute malaria. Immunoglobulin levels normalized after chemotherapy. A striking decrease of CD4+ peripheral blood lymphocytes, normalizing after chemotherapy, was seen in both patient groups, and was more pronounced in nonimmune patients. A slight increase in interleukin-2 receptor (IL-2R)-bearing cells was found in nonimmune patients. In addition, soluble plasma IL-2R was significantly elevated in them (P less than .001) and to a lesser extent in semiimmune patients. These findings were paralleled by significantly decreased IL-2 concentrations in plasma (P less than .001) during the acute phase of malaria, suggesting pronounced general immunosuppression in nonimmune malaria patients.

Adolescent↗
PubMed1990

Intravenous ofloxacin in severe infections.

The efficacy and tolerance of intravenous ofloxacin was studied in 70 patients suffering from soft tissue infections (n = 33), intra-abdominal abscesses (n = 14), septicaemia (n = 12), pneumonia (n = 9) and brucellosis (n = 2). The average daily dose was 6 mg/kg divided into two doses. Pathogens treated included Enterobacter cloacae (n = 14), Escherichia coli (n = 12), Staphylococcus aureus (n = 13), Pseudomonas aeruginosa (n = 11), Klebsiella pneumoniae (n = 10), Enterococcus faecalis (n = 8) and Streptococcus spp. (n = 5). Most patients had several underlying diseases. Most of the patients had received other antibiotic therapy without success. Clinically, 41% were considered cured, 19% improved and 30% failed to respond. Bacteriologically, pathogens were eradicated in 52.5% and persisted in 22.5%. Adverse reactions included an anaphylactoid reaction, abnormal liver function (n = 13) and insomnia (n = 2). This study suggests that higher doses of ofloxacin may be needed in deep seated infections.

Adolescent↗
PubMed1990

Interstitial lung disease in progressive systemic sclerosis: high-resolution CT versus radiography.

High-resolution computed tomographic (HRCT) scans and chest radiographs were obtained in 23 patients with progressive systemic sclerosis (PSS) to assess the diagnostic merits of HRCT compared with chest radiography in detecting interstitial lung involvement in these patients. HRCT scans showed interstitial disease in 21 patients (91%). The most frequent finding was the so-called subpleural lines, which were demonstrated in 17 patients (74%). Honeycombing was seen in seven patients (30%), while parenchymal bands were seen in six patients (26%). Chest radiographs, on the other hand, showed definite interstitial opacification patterns in only nine patients (39%); six patients (26%) had equivocal reticular areas of attenuation, while eight patients (35%) had normal chest radiographs. Thus, HRCT is much more sensitive than chest radiography when assessing minimal interstitial lung involvement in patients with PSS.

Female↗
PubMed1990

[Preoperative autologous blood donation, effect of hydroxyethyl starch on the reticuloendothelial system and opsonins].

The effect of 6% low molecular weight (LMW) HES (MW 270,000) on reticuloendothelial function was studied in 9 male patients, median of age 50 years, who were scheduled for vascular surgery. An erythrocyte clearance test (Anti Rh) labeled with 99 mTc, evaluating primarily the splenic section of the RES, showed a considerable variation (37-87%) prior to hemodilution. 24 hours after replacement of 15 ml/kg body weight of blood, there was no significant change of the clearance rate, a follow up weeks later approached the base line values. Plasma opsonins like fibronectin, complement fraction 3, complement fraction 4 and immunoglobulin G showed a proportional decrease following hemodilution, and after 24 hours approached control levels. Changes at this time seemed to be independent from the course of the hematocrit. It is concluded that LMW HES does not adversely influence the spleen dependent phagocytic capacity of the RES system.

Blood Transfusion, Autologous↗
PubMed1990

[Plasma proteins in the early postoperative course after liver transplantation].

The levels of fibronectin, alpha-1 antitrypsin, and fibrinogen have been studied in 34 patients after orthotopic liver transplantation (OLT). Patients were grouped according to A: postoperative course without complications (n = 18), B: development of sepsis accompanied by organ insufficiency (n = 8), and C: acute rejection (n = 6). The plasma levels of alpha-1 antitrypsin and fibrinogen did not show a typical pattern with respect to the postoperative course. The levels of fibronectin, however, did respond to the postoperative events. Starting from a subnormal level a significant increase was observed in group A (p less than 0.005) and C (p less than 0.05) whereas in group B plasma levels remained low. Significant differences (p less than 0.05) were found on day 3 and 5 between group A and C and group B and C. At the end of the observation period survivors (group A and C) had significantly higher levels of fibronectin than nonsurvivors (group B). Therefore fibronectin might aid to diagnose immunologic disturbances after OLT.

Adult↗
PubMed1989

[Infectious diarrhea diseases].

Gastroenteritis may be due to many agents, infectious or non infections. Most cases of infections diarrhea are selflimited--e.g. food born intoxications with 1 to 2 days duration or infections with enteropathogenic E. coli, Salmonella spp., Vibrio parahaemolyticus or rota virus. Even the majority of shigellosis, salmonella-gastroenteritis and infections with Campylobacter fetus cease without treatment within 4 days. Fever and diarrhea persisting for more than 4 days justify the use of antibiotics, favourably trimethoprim and quinolones. Fluid and electrolyte replacement is the mainstay of treatment. Antimotility agents worsen some forms of diarrhea (especially these due to enteroinvasic bacteria) by retarding the natural purgative effect of diarrhea.

Bacterial Infections↗
PubMed1989

Antinuclear antibodies in patients with chronic idiopathic autoimmune thrombocytopenia followed 2-30 years.

We determined whether serological investigations can assist to distinguish between chronic idiopathic autoimmune thrombocytopenia (cAITP) and immune-mediated thrombocytopenia in patients at risk to develop systemic lupus erythematosus (SLE); 82 patients were seen in this institution for the evaluation of immune thrombocytopenia. In nine of these patients a diagnosis of SLE was made at presentation or shortly thereafter. In the remaining 73 patients with an established diagnosis of cAITP we obtained serum samples at a median disease duration of 7 years; 45 patients were investigated again 2 years later. cAITP patients suffered from their disease for up to 30 years (median 7 years, range 2-30 years) without developing clinical features of SLE. Elevated antinuclear antibodies were found in all patients with a diagnosis of SLE but also in seven patients with established cAITP. All patients who had thrombocytopenia in association with SLE had additional antibodies to anti-nDNA and/or antibodies to soluble cellular antigens. Neither in the initial, nor in the follow-up investigation, such antibodies were discernible in patients with cAITP. We conclude that patients with cAITP do not develop SLE and do not form antibodies to defined cellular antigens, even if suffering from the disease for many years. The ANA titer does not help to differentiate cAITP from thrombocytopenia of SLE. A differentiation, however, between the two diseases is possible by the combined screening for antinuclear antibodies, anti-nDNA, and antibodies to defined soluble cellular antigens.

Adult↗
PubMed1989

Demonstration of a new antinuclear antibody (anti-RA33) that is highly specific for rheumatoid arthritis.

Using immunoblot analysis with soluble nuclear extracts from HeLa cells, we identified autoantibodies to an antigen with a molecular weight of approximately 33,000 in 36% of 95 sera from rheumatoid arthritis patients, but in only 1 of 170 controls. The antigen, termed RA33, was resistant to DNase and RNase digestion but sensitive to proteinase K treatment. There was no discernible relation to other autoantibodies. Thus, this newly described autoantibody appears to be highly specific for rheumatoid arthritis.

Adult↗
PubMed1989

Immunological alterations in uncomplicated Plasmodium falciparum malaria. Relationship between parasitaemia and indicators of macrophage activation.

Numerical alterations of circulating lymphocytes were investigated in 37 Brazilian patients with uncomplicated Plasmodium falciparum malaria and in a group of 15 healthy controls. The number of CD4+ T helper/inducer cells was significantly lower in patients than controls, whereas absolute numbers of CD8+ suppressor/cytotoxic T cells did not differ between the groups. TNF and neopterin levels were markedly increased in the plasma of patients and remained slightly elevated after chemotherapy with clindamycin. Neopterin, but not TNF levels, were significantly correlated with parasitaemia. TNF was inversely related to monocyte counts. Interferon gamma could not be detected in the plasma of control subjects and was observed in only one patient. We conclude that in uncomplicated falciparum malaria the distribution of phenotypes of circulating lymphocytes are altered slightly and that the high plasma levels of TNF and neopterin indicate excessive release of these molecules by activated macrophages and the activation of cellular immune mechanisms during the infection.

Adolescent↗
PubMed1989

Assessment of oxygen-consumption by use of reverse Fick-principle and indirect calorimetry in critically ill patients.

Oxygen consumption was measured simultaneously by the reverse Fick-principle (V02FICK) and by indirect calorimetry ("Metabolic Measurement Cart Horizon") (V02MMC) in 31 critically ill patients; 24 men and 7 women. Seventeen patients were breathing spontaneously, 14 patients were on mechanical ventilation. The fractional inspiratory oxygen concentration (FI02) in ventilated patients ranged from 0.21 to 0.4 (mean 0.302). Total oxygen consumption as measured by indirect calorimetry was 286.7 +/- 59.7 ml/min (mean +/- SD), and measured by reverse Fick-principle 258.9 +/- 52.2 ml/min (mean +/- SD). The coefficient of correlation between the two methods was r = 0.873. The absolute difference of oxygen consumption between reverse Fick-method and indirect calorimetry was 11.3%. Regression analysis according to Theil revealed a similar regression between spontaneously breathing and mechanically ventilated patients for the studied FI02 values below 0.4. It is concluded that indirect calorimetry is a reliable method for measuring oxygen consumption in spontaneously breathing as well as mechanically ventilated critically ill patients.

Journal Article↗
PubMed1989

Clindamycin treatment of falciparum malaria in Brazil.

Oral treatment with clindamycin (5 mg/kg twice a day, for five consecutive days) was studied in patients with uncomplicated falciparum malaria in Acre, Brazil, an area with multiresistant Plasmodium falciparum. Parasitaemia ranged between 12 and 79560/microliters of blood admission. Thirty-five out of 44 patients admitted to the study could be followed up for 28 days. Only two patients showed parasitaemia six days after admission, and no asexual parasites were observed by day seven. Twenty-eight days after admission all patients were cured. Of the nine patients withdrawn from the study, five were lost during follow up and four needed different treatment (quinine 15 mg/kg twice a day, for ten days) because clinical symptoms did not improve within 60 h after admission. These patients had experienced their first attack by P. falciparum. In individual cases oral clindamycin can be used as an alternative treatment in semi-immune patients with uncomplicated falciparum malaria from an area where multiresistant parasites frequently occur. However, because of the slow response in all cases described here, and the risk of development of resistance if clindamycin is used alone it cannot be recommended as monotherapy in non-immune patients.

Adolescent↗
PubMed1989

Activity of clavulanate-potentiated penicillins against methicillin-resistant Staphylococcus aureus.

It has been suggested that combinations of penicillins with clavulanate may be useful in treatment of infections by methicillin-resistant strains of Staphylococcus aureus (MRSA). To determine the potentiating effect of clavulanate on the antibacterial activity of penicillins, we studied MRSA in vitro by an agar-dilution method. A total of 124 clinical isolates of MRSA were tested for sensitivity to benzylpenicillin, amoxycillin, and ticarcillin alone and in combination with 1.25, 2.5, 5.0 and 10.0 mg/l of clavulanate. Most of the strains were not typable by the international reference set of bacteriophages of human staphylococci but showed typical properties of nosocomial strains. A reduction in the MIC90 of benzylpenicillin and amoxycillin to 25 mg/l was seen in the presence of 2.5 mg/l of clavulanate. The effect was less pronounced with ticarcillin. In spite of some increase in the susceptibility of MRSA to benzylpenicillin and amoxycillin produced by clavulanate, these combinations seem to be inappropriate in infections due to MRSA.

Clavulanic Acids↗