Biomedical subjects

H Chlebowski

Publications and source records attributed to H Chlebowski.

4 recordsLinked to original sources

PubMed1992

[A lethal course in pseudomembranous enterocolitis during the parenteral administration of vancomycin and imipenem].

A 48-year-old woman required mechanical ventilation after aortic valve replacement for decompensated aortic valve stenosis when bleeding complications developed and rethoracotomy had to be performed. Acute renal failure necessitated haemodialysis. Septic fever of unknown aetiology failed to respond to oxacillin, cefotaxim and tobramycin. The endotracheal cannula and central venous catheter were changed on the 24th postoperative day and the antibiotic treatment altered to 250 mg imipenem and 125 mg vancomycin three times daily intravenously. The fever soon subsided, but recurred on the 32nd postoperative day, accompanied by increasing leucocytosis. The patient was obstipated but had no intraabdominal signs. Four days later ultrasonography demonstrated thickening of the intestinal wall and coloscopy showed typical pseudomembranous colitis. Intestinal contents were positive for Clostridium difficile toxin. Despite immediate rectal and intragastric administration of 250 mg vancomycin four times daily the patient died of pseudomembranous colitis, confirmed at autopsy. The case demonstrates that vancomycin cannot always prevent the development of pseudomembranous colitis.

Colon↗

PubMed1992

[Pneumocystis carinii pneumonia: a life threatening complication after kidney transplantation].

Aggressive immunosuppression in kidney transplantation increases the risk of opportunistic infections. We report ten cases of pneumocystis carinii pneumonia in a group of 420 kidney recipients (2.1%). All patients showed a severe--hyperacute--course of the infection. One patient required mechanical ventilation. In all cases the diagnosis could be established applying fibreoptic bronchoscopy with lavage and partly using transbronchial biopsy. The therapy consisted of intravenous cotrimoxazole and inhalation of pentamidine. All patients survived even after severe course of the disease. Graft explantation for saving patients was not necessary.

Administration, Inhalation↗

PubMed1990

Changes of peritoneal membrane function during long-term CAPD.

Peritoneal equilibration tests (PETs) in patients on CAPD show wide variations. To find out whether these are correlated with time on CAPD, we investigated changes in PET in 97 tests in 86 patients. 46 PETs were performed with a 1.36% glucose solution and 40 PETs with a 3.86% glucose solution at different time intervals. Neither did the intra-individual comparison of 11 patients with 1.36% glucose solution following 1 year of treatment show any significant change nor the inter-individual comparison following a treatment time of 1 and 2 years. There was also no difference using a 3.86% glucose exchange, when the results at the beginning and after 1 year were compared. However, alterations in equilibration ratios were significant after 24 and 36 months of treatment for creatinine (36 months versus 0: p less than 0.005), glucose absorption (36 months versus 0: p less than 0.01) and UF (36 months versus 0: p less than 0.01). No correlation exists between these changes either with the number of peritonitis episodes or with the time of treatment. Though, no single factor could be identified, patients had an increase in peritoneal permeability especially after long-term treatment. Further investigations are necessary to evaluate the reasons for these changes.

Diabetic Nephropathies↗

PubMed1989

[Conversion of inactive renin to active renin following acute angiotensin converting enzyme inhibition in essential hypertension and renovascular hypertension].

The physiological role of inactive renin, especially the question of whether and how a conversion to active renin takes place in vivo, remains controversial. In order to show the dynamic alterations from inactive to active renin following acute ACE-inhibition, both forms of renin were investigated in both renal veins and the peripheral circulation of 20 patients with essential hypertension and 20 patients with renovascular hypertension before and 1 h after 25 mg of captopril. Active and inactive renin were determined indirectly as plasma renin activity (PRA, unit: ng/ml x h). In vitro activation of inactive renin was achieved with trypsin (1 mg/ml plasma), followed by a further determination of PRA (= total renin). Subtraction of the active renin from the total renin yields the amount of inactive renin. In patients with essential hypertension, the mean values of active renin increase equally in both renal veins (1.4 and 1.3 before, 1.9 and 1.8 after captopril) and the peripheral circulation (0.9 and 1.3) (p less than 0.002), whereas the inactive renin decreases correspondingly. Renal veins: 7.6 and 8.2 before, 7.2 and 7.6 after captopril; peripheral circulation: 7.7 before and 7.0 after captopril (p less than 0.05). In all patients with renovascular hypertension, there is basally a marked lateralization of active renin (6.4 vs 3.5; p less than 0.01) and inactive renin (20.5 and 18.9, p less than 0.03) towards the side of the ischemic kidney. After captopril, the values for total renin and active renin increase (p less than 0.001), and the side difference for active renin becomes still more pronounced (33.0 vs 14.2; p less than 0.001).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗