Biomedical subjects
Publications and source records attributed to W Graninger.
Serum levels of cefotaxime and desacetyl-cefotaxime were studied in 18 patients with hepatic cirrhosis after an intravenous bolus injection of 2 g of cefotaxime. Blood levels were independent of the degree of hepatic dysfunction and did not differ from those reported in normal individuals.
Fibronectin plasma concentrations were determined in 28 children with type I diabetes mellitus and 22 healthy children. No statistically significant difference was observed between the fibronectin concentrations in diabetic and non-diabetic children. Even in children with poor glycaemic control the fibronectin concentrations (glycosylated haemoglobin greater than 10%) were not significantly higher.
After an episode of intermittent fever which lasted 45 days, endocarditis of the tricuspid valve was diagnosed using M-mode echocardiography in a 17-year-old female patient who had no history of drug abuse. After unsuccessful therapy with ampicillin, tetracycline and aminoglycosides, clinical improvement was achieved by treatment with temocillin.
In nine adult patients at least 24 hours prior to vascular surgical operations about 25 p.c. of circulating blood volume was replaced by either 6 p.c. hydroxyethyl starch (HES) or 5 p.c. plasmaprotein solution (PPS). Following haemodilution, a proportional significant decrease of plasmafibronectin (PFN) was observed; when PPS was administered, levels were significantly higher than expected due to withdrawal of blood. Serumalbumin was decreased in the same way, however, in patients receiving HES it rose significantly within 24 hours. It is concluded that changes are essentially only dilutional and when haemodilution technique is used, also postoperatively no dramatic reduction of PFN following uncomplicated surgery has to be anticipated.
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The diagnostic value of 7 laboratory parameters for the detection of metastases was investigated in 136 patients with verified breast carcinoma after mastectomy. The post-operative interval was 6 to 80 months (means = 27.5). 61 patients had multiple metastases as determined by physical examination, X-rays, computertomography, sonographic and scan procedures, while the other 75 patients had no evidence of metastases. Carcinoembryonic antigen (CEA), alkaline phosphatase (AP) and lactate dehydrogenase (LDH) proved to be reliable parameters for the presence of metastases; the combination of these 3 parameters had a sensitivity of 73.0% and a specificity of 94.7% in the detection of metastases. The additional determination of gamma-glutamyltranspeptidase (gamma-GT), blood sedimentation rate (BSR), C-reactive protein (CRP) and serum iron (Fe) increased the sensitivity of metastases detection to 83.8%, but the specificity decreased to 46.2%.
Reduced levels of glycosylated hemoglobins (GHb) have been found to be closely related to red cell survival. We therefore studied the relation of this parameter to the clinical applicability in patients with hemolytic disease (n = 20). During a 5-week period we repeatedly measured severity of anemia, i.e., hemoglobin (Hb), packed red cell volume (VPRC), and red blood cell count (RBC), as well as reticulocytosis and parameters of red cell destruction such as serum concentration of lactic dehydrogenase (LDH) and bilirubin together with GHb. There was a weak correlation between simultaneously measured GHb and RBC (r = 0.5, P = 0.02), but none was demonstrable between GHb and Hb, VPRC, reticulocyte counts, LDH, or bilirubin. A much closer correlation, however, was found between actual GHb levels and RBC determined 3-5 weeks previously (r = 0.72, P = 0.001), as well as Hb (r = 0.56, P = 0.015), VPRC (r = 0.57, P = 0.013), reticulocyte counts (r = -0.63, P = 0.006), LDH ( r = -0.53, P = 0.02), and serum bilirubin concentrations ( r = -0.55, P = 0.016). Ghb was also significantly decreased in patients with consistently low values of reticulocytes when red cell destruction was demonstrable. These results show that GHb is a measure of red cell destruction and restitution, and thus may be usefull for long-term monitoring of patients with hemolytic disease.
Between 1978 and 1980, 10 patients with myasthenia gravis underwent treatment by plasmapheresis. Of these, 7 responded to plasma exchange. Pre- and post-exchange anti-acetylcholine receptor antibody concentrations were found to be a useful parameter for intraindividual comparisons, but failed to correlate with the stage of the disease. Anti-acetylcholine receptor antibody assays cannot be replaced by determinations of IgG and globulin concentrations. In view of the potential risks and of the high cost factor, plasmapheresis should be reserved for particularly severe cases for obtaining transient clinical improvement in life threatening situations.
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Polyneuropathy occurring during therapy with D-penicillamine is reported in a 63 year-old women with chronic rheumatoid arthritis. 6 weeks after recommending therapy with 500 mg D-penicillamine/day the patient developed bilateral oculomotor palsy and axonal peripheral neuropathy. The development of clinical symptoms was accompanied by the observation of high levels of antinuclear antibodies and antibodies against native DNA. The appearance of polyneuropathy after repeated administration of penicillamine, the regression of symptoms and the rapid decrease in antinuclear antibodies after discontinuation of the drug plus the absence of signs of a malignant form of rheumatoid arthritis show a remarkable correlation.
Doxorubicin (Adriamycin) has shown impressive activity in the treatment of a broad spectrum of malignant tumours. Chronic irreversible cardiac myopathy is the usual cumulative dose-limiting toxicity with this anthracycline antibiotic. In this study acute cardiac reactions following doxorubicin infusions (60 mg/m2) were registered by means of ECG Holter monitoring and measurement of systolic time intervals. The PEPI as well as the PEP/LVET ratio were found to be significantly increased, with a peak at 6 hours following drug infusion (p less than 0.001). This observation proves the occurrence of transient myocardial dysfunction during doxorubicin treatment. Pharmacokinetic data showed good correlation between the electrocardiographic changes and the tissue distribution of the drug. Doxorubicin-related ventricular arrhythmias were observed in only 2 out of 6 cases. Repeated acute myocardial damage by doxorubicin infusions is considered to be the cause of chronic cardiomyopathy with long-term administration.
In two hospitals an identical diabetes teaching and treatment programme (in-patient, Monday to Friday, group teaching) was set up. Seventy-eight consecutive, conventionally treated Type 1 diabetic patients (duration of diabetes 10 +/- 6 years), referred during a certain period, were reinvestigated after 1 year, and again (for assessment of metabolic control only) 22 months after the teaching and treatment programme. Initially, mean glycosylated haemoglobin was 2.6%, after one year 1.0%, and after 22 months 1.5% above the upper limit of the normal range (p less than 0.001). Hospital admissions were reduced from a mean of 10 to a median of 1 day per patient per year (p less than 0.001). The long-term quality of diabetes care achieved by the diabetes teaching and treatment programme was unrelated to intelligence quotient, diabetes duration, or diabetes-related knowledge. Patients with normal levels of glycosylated haemoglobin on follow-up (33% of all patients) had particularly good compliance rates, and significantly lower initial values of glycosylated haemoglobin than patients with glycosylated haemoglobin levels greater than or equal to 10%. The data indicate that the diabetes teaching and treatment programme resulted in a substantial long-term improvement of metabolic control and a striking reduction of hospital admissions. The study substantiates the feasibility of applying this teaching and treatment programme on a large scale to other hospitals, so as to improve the quality of diabetes care and decrease health care costs.
Ninety-eight female patients (mean age 54 years) who underwent doxorubicin therapy because of metastatic breast cancer were submitted to radionuclide angiography at rest. Left ventricular ejection fractions (LVEFs) were found to decrease significantly with the increasing cumulative doxorubicin dosage. Patients with prior local radiotherapy showed lower LVEFs at the same dosage level than nonirradiated patients, but the difference was not statistically significant. In a further study, 52 patients (mean age 56 years) were followed up regularly for their history and systolic time intervals prior to each doxorubicin treatment course. Before starting treatment, LVEF values were normal in all cases. Fifteen of these patients complained of dyspnea at some time during the treatment period before the critical cumulative dosage level of 550 mg/m2 was reached. Nine of these 15 patients showed an increase of the PEPI:LVETI ratio (greater than or equal to 0.40) and 12 patients a decrease of the LVEF values at rest at the same time. The rest of the patients did not complain of cardiac symptoms and did not show any significant alterations in systolic-time-interval measurements until the borderline dosage level (550 mg/m2) was attained. To evaluate myocardial function with greater accuracy, these 15 patients were submitted to right-heart catheterization and radionuclide angiography at rest and during exercise. As a result, doxorubicin treatment had to be discontinued in three of these patients because of heart failure of stage III or IV and treatment with methyl digoxin and nifedipine was started. In these three patients cardiotonic medication could produce more or less complete cardiac recompensation. We conclude from our findings that signs of stage-III heart failure in radionuclide angiography performed while the patient is at rest and exercising should be regarded as the upper limit of the therapeutic risk, where further doxorubicin treatment is contraindicated. Cardiotonic medication during cytostatic courses should be avoided, however, because the true functional condition of the myocardium could be masked during a potentially cardiotoxic therapy.
In 100 consecutive patients the occurrence of bacteraemia and endotoxaemia after colonoscopy was studied. The Limulus Amoebocyte Lysate Test was used to detect endotoxaemia. No bacteraemia was detected after colonoscopy. Growth of Staph, epidermidis was considered as contamination. In 9% of the patients endotoxaemia was discovered after colonoscopy. The occurrence of endotoxaemia was found to be unrelated to the duration of the procedure, the number of the biopsies taken, or the cleansing of the bowel prior to colonoscopy. In patients with liver cirrhosis endotoxaemia occurred more often than in patients without liver disease. No clinical consequences of endotoxaemia were found in patients who developed endotoxaemia after colonoscopy. We conclude that colonoscopy is followed by endotoxaemia quite frequently. The clinical implication of these conditions, especially in patients with liver cirrhosis merits further consideration.
A case of teratoma and choriocarcinoma of the testis with a single metastasis to the jejunum is described. The patient had suffered from severe intestinal hemorrhage for several weeks. An uneventful endoscopic removal of the metastasis was performed. The report illustrates that, particularly in young patients, metastatic lesion of the small bowel should be considered a possible cause of intestinal bleeding in patients who have neoplasm.
Plasma fibronectin was determined during normal pregnancy after 15th week, post partum, in cord blood and in cases of EPH gestosis. Non-pregnant women of a comparable age group were examined for plasma fibronectin concentration. Fibronectin at the end of gestation was at about the same level as at the beginning of the second trimester and as in non-pregnant women. The amount of fibronectin remains post partum practically the same. Cord blood fibronectin was about half the concentration of that in adult plasma. In EPH gestosis, levels were significantly elevated.
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