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Biomedical subjects

G Lahnborg

Publications and source records attributed to G Lahnborg.

At least 19 recordsLinked to original sources

Efficacy of L-627, a new carbapenem, in the treatment of experimentally induced intra-abdominal infections in rats.

A reproducible experimental model of intra-abdominal infections in rats has been devised in order to simulate intra-abdominal sepsis in patients. Pre-operatively, the rats were fed lean ground beef for two weeks in order to change the intestinal flora to one similar to that of humans. A 1-cm segment of ileum was isolated on its vascular pedicle. The intestine was then divided at each end of the segment and intestinal continuity was re-established by an end-to-end anastomosis. The segment of ileum was then returned to the abdominal cavity. This experimental model was used to compare the efficacy of L-627 with the combination of gentamicin plus metronidazole. Eighty per cent of the untreated animals died within three days. Animals treated with L-627 or gentamicin plus metronidazole had significantly decreased mortality and increased cure rates during the experimental period. Only two animals in the two treatment groups died. L-627 seems to be as useful as gentamicin plus metronidazole in the treatment of intra-abdominal infections.

Abdomen

Reticuloendothelial function in human renal allograft recipients.

The phagocytic and metabolic functions of the reticuloendothelial system (RES) were determined, by measuring the plasma clearance rate of 125I-labelled microaggregated human serum albumin and the increase in plasma metabolites of this test substance, in patients with chronic renal failure and in renal transplant recipients at different times after transplantation. All transplant recipients received triple immunosuppressive therapy consisting of azathioprine, corticosteroids, and antilymphocyte globulin. The intravascular clearance of microaggregated albumin was significantly depressed in patients when tested at 1 to 12 days (P less than 0.001), 1 to 4 months (P less than 0.02), and 6 to 9 months (P less than 0.001) after transplantation compared to pretransplantation. The 1- to 3-year transplant survivors had a normal RES phagocytosis. Furthermore, the metabolic RES function in all groups of transplant recipients except the group of patients tested at 1 to 4 months after transplantation was significantly impaired compared to pretransplantation. Administration of antilymphocyte globulin and extremely high daily doses of steroids were probably responsible for the significant depression in the RES functions recorded immediately post-transplantation. The further development of the phagocytic ability of the RES was shown to be correlated to the cumulative dose of steroids given over the last 12 months. The azathioprine regime seemed to have no influence on the RES functions.

Adult

Effect of dextran infusion on the phagocytic and metabolic functions of the reticuloendothelial system in man.

The reticuloendothelial system (RES) is part of the host defence and consequently plays an important role in shock and trauma, conditions often requiring volume replacement. Experimental studies have shown that the functions of the RES are hampered by plasma substitutes such as gelatin, starch and dextran. In this study six patients undergoing elective cholecystectomy were given 500 ml dextran just before the operation. At the end of the operation the phagocytic and metabolic functions were tested with microaggregated human serum albumin labelled with I125. The results indicate that there is a significant impairment of the phagocytic activitity of the RES in patients given dextran compared to controls not given dextran but saline. The metabolic activity was not significantly affected by dextran, however, suggesting that moderate dosage of dextran is not of great disadvantage to patients undergoing major surgery.

Cholecystectomy

Human granulocyte function during dextran infusion.

The granulocyte function was determined in healthy persons before and immediately after the infusion of 500 ml of dextran for 4 hours. The nitroblue tetrazolium (NBT) reduction reflecting the metabolic activity of these cells was measured both in cells at rest and after stimulation with E. coli, as well as with and without the addition of plasma. In 13 persons, the NBT-reduction was slightly but significantly increased in all four types of experiments after the dextran infusion. When dextran was added in vitro to granulocytes from normal volunteers, the NBT reduction of these cells was increased and the effect was dose-dependent. A surface effect of dextran together with phagocytosis of dextran molecules are the most probable reasons for the elevated NBT-reduction. - In 9 persons tested, the bactericidal capacity was not significantly influenced by dextran infusion. - When dextran was added in vitro to granulocytes neither the bactericidal capacity nor the chemotactic and random migration of the cells were changed. -

Adult

Role of phagocytic cells in host defence in relation to trauma--a brief review.

Present evidence available support a relationship between phagocytic cell function and survival from various types of trauma, e.g. burn, traumatic shock, and haemorrhage. Both polymorphonuclear phagocytes and mononuclear phagocytes (monocytes and macrophages) participating in the body's host defence are of crucial importance in preventing post-traumatic infections by microorganisms. The role of macrophages constituting the reticuloendothelial system (RES) in relation to trauma is paid special attention in this review. Deficit in a humoral opsonic glycoprotein (alpha 2 SB glycoprotein) important for reticuloendothelial phagocytosis is described in various types of traumatic injuries, and the role of RES in relation to pulmonary insufficiency is finally summarized.

Animals

Immunoassay of macrophage stimulating alpha 2 SB (surface binding) glycoprotein in pig plasma following missile trauma.

Pigs were subjected to a standardized missile trauma in the thigh and plasma samples were collected at various times after trauma. The plasma level of an opsonic alpha 2 SB (surface binding) glycoprotein related to macrophage phagocytosis was determined by an agglutination assay using 125I-labelled gelatin particles. The results indicated a transient but significance decrease (p less than 0.01) in the plasma agglutination activity after trauma reflecting a deficiency in plasma alpha 2 SB glycoprotein. One non-surviving animal showed a persistent decrease in the plasma level of alpha 2 SB glycoprotein, while the surviving animals showed a normalization indicating that this agglutination assay may have prognostic value during the course of posttraumatic therapy.

Agglutination Tests

Human granulocyte and reticuloendothelial system function during intralipid infusion.

In six patients, the phagocytic and catabolic functions of the RES (reticuloendothelial system), as measured by using 125I-microaggregated human serum albumin as a test substance, were not affected by Intralipid infusion. The nitroblue tetrazolium (NBT) reduction of granulocytes, the NBT reduction and the bacplasma, was significantly lower in eight patients during Intralipid infusion than before this treatment. When heat-killed E. coli were added for phagocytic stimulation in vitro, the same result was obtained only in the absence of plasma. The bactericidal capacity of granulocytes was significantly decreased in six patients during Intralipid infusion. When Intralipid was added in vitro to granulocytes, the NBT reduction, and the bactericidal capacity of these cells were decreased and the effect was mainly dose-dependent. Electron micrographs show that granulocytes phagocytize Intralipid. The loading of granulocytes with lipid particles may block the engulfment of bacteria and may be a reason for the decreased bactericidal capacity of these cells. An influence exerted by the lipid on the cell membrane is the most conceivable reason for the decreased NBT reduction.

Adult

Phagocyte function in various situations in surgery.

A brief presentation is given of granulocyte physiology, as well as some techniques in use for assessing the adherance, the migration, the uptake and bacterial killing and finally the metabolic activity of these cells. Also the activities of the reticuloendothelial system and an in vivo method to measure the phagocytic and metabolic function of macrophages are described. A change, most often a decrease, in phagocytic function has been noted in several circumstances common in surgical practice. So is the case after open heart surgery, during infusion with colloids for blood replacement, and during treatment with immunosuppressive drugs. Further, various forms of malnutrition, such as total starvation, obesity and the hypertriglyceridemia following excessive infusion of fat emulsions may impair granulocyte function.

Cell Movement

The Mallory-Weiss syndrome. A review of 23 cases with special reference to coagulation defects.

The Mallory-Weiss syndrome is defined as bleeding from longitudinal tears in the gastro-oesophageal junction. The characteristic history consists of repeated vomiting followed by sudden haematemesis. During the past 4 1/2 years, 23 patients, 17 males and 6 females with the diagnosis of Mallory-Weiss syndrome were treated in our institution. An aetiological factor has been sought for. In a review of the case-records, we discovered that many patients had coagulation defects on admission. This was verified with extended coagulation tests at later follow-up. It is proposed that non-bleeding lacerations in the cardiac orifice in conjunction with vomiting is a common occurence, and that the Mallory-Weiss syndrome may be regarded as a complication occuring predominantly in patients with some coagulation defect.

Adult

Effect of low-dose heparin prophylaxis on arterial oxygen tension after high laparotomy.

The effect of low doses of heparin (5000 units of sodium heparin every 12 hours for 5 days) on arterial oxygenation was studied in 24 patients in the postoperative period after upper abdominal surgery. Another 24 patients served as a control group. The arterial oxygen tension was the same in both groups preoperatively and was equally significantly reduced during the 1st postoperative day. During the 2nd day, oxygen tension rose in the heparin-treated group to values which no longer differed significantly from the peroperative level. In the control group the significant reduction persisted until the 4th postoperative day. The arterial carbon-dioxide tension did not differ between the groups, neither did it vary significantly between days. There were no clinical signs of large pulmonary embolism during the postoperative period, chest X-ray was normal in all patients examined and a photoscan was normal in 23 of 24 subjects studied. Low-dose heparin treatment may apparently shorten the period of postoperative hypoxaemia, probably by counteracting both large pulmonary emboli and microthromboembolism.

Adult

Induced fat embolism in rabbits: effects of defibrinogenation and thrombocytopenia.

Fat embolism was induced in rabbits by giving an intravenous injection of radioactively labelled homologous retroperitoneal fat. One group was defibrinogenated by Arvin. A second group was made thrombocytopenic by treatment with Busulphan. After the animals had been made thrombocytopenic and had been defibrinogenated, respectively, fat embolism was induced. Macroscopic and histologic examinations were carried out, as well as recordings of wet weight and radioactivity content of the lung. There was a highly significant increase in the pulmonary wet weight of thrombocytopenic animals compared with controls. Macroscopic as well as histologic examination revealed a massive interstitial and alveolar oedema. Half of the specimens showed moderate to massive bleedings. Defibrinogenated animals did not differ from controls. Under the given circumstances, the results suggest that platelets are protective to the endothelial lining of the pulmonary capillaries during embolism. The presence or absence of fibrinogen initially does not seem to be of major importance for the pulmonary damage induced by fat injection.

Ancrod

Effect of low-dose heparin on the phagocytic and catabolic function in the reticulo-endothelial system in man during surgery.

The effect of subcutaneous low-dose heparin prophylaxis on the phagocytic and catabolic functions of the reticuloendothelial system (RES) was studied in 10 patients undergoing elective cholecystectomy. The patients were divided into two groups; 5 patients receiving 5 000 units of heparin preoperatively and every 12 hours following the operation and 5 patients given saline at the corresponding time. Each patient served as his own control, when the RES function was tested twice with microaggregated human serum albumin labelled with 125I as a test substance. There was an enhanced phagocytic activity and a correspondingly raised catabolic activity of the RES in patients treated with heparin. The reasons for this are discussed. The results indicate that heparin in low doses has a favourable effect on the RES.

Heparin