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Biomedical subjects

J Horn

Publications and source records attributed to J Horn.

At least 19 recordsLinked to original sources
PubMed1992

[Role of surgical therapy in acute pancreatitis].

Thirty-four of 44 patients with severe necrotizing pancreatitis were operated on. One patient died as a result of an undiagnosed pneumothorax. The mortality of the patients in stage II and III was accordingly 2.1% and 2.9% for the patients operated-on. In accordance with the possibilities of surgical therapy, four principles are defined. The corresponding repertoire of methods is shown. Following these principles it is necessary to individualize the methods for each patient.

Acute Disease↗
PubMed1992

[Intensive care medicine in advanced age from the viewpoint of the internist].

BASIC REMARKS: The percentage of elderly patients in ICUs has doubled over the last 20 years; in the case of the over-seventy-year-olds it is at present about 30%. MAJOR DISCUSSION POINTS: The mean length of stay in the ICU and hospital, and the average costs incurred, are not significantly higher in the case of the elderly. With increasing age, mortality rises steadily, being about 20% for geriatric patients in the ICU, 37% in hospital, and 52, cumulative, after one year. Nevertheless, elderly patients benefit in particular from intensive care. Their relative mortality rate in comparison with the general population of the same age is only slightly elevated. In view of the very high mortality following cardiopulmonary resuscitation of geriatric patients, it would make good sense to limit the indication in particular cases. Quality of life after discharge from ICU care and thereafter is appreciably lower in comparison with younger patients, but acceptance of intensive care is very good among elderly patients, too. As a study we carried out in our "toxicological" ICU showed, prognostic scoring systems for the elderly are not particularly reliable, and the geriatric skills and the knowledge of the physician weigh heavier. CONCLUSIONS: We consider intensive care in the elderly to be both beneficial and efficient, for despite an increase in the mortality rate, a satisfactory quality of life is achieved.

Aged↗
PubMed1992

Verapamil inhibits ethanol elimination and prolongs the perception of intoxication.

Ten young healthy men received verapamil (80 mg every 8 hours for 6 days) or placebo in a blinded, randomized, crossover design. On the sixth day, ethanol was administered as a single oral dose (0.8 gm/kg), and blood samples were collected over the following 12 hours for determination of verapamil, norverapamil, and ethanol concentrations. Compared with placebo, verapamil increased the peak blood ethanol concentration (106.45 +/- 21.40 to 124.24 +/- 24.74 mg/dl, p less than 0.05) and area under the ethanol concentration versus time curve (365.67 +/- 93.52 to 475.07 +/- 97.24 mg.hr/dl, p less than 0.005). Verapamil areas under the concentration versus time curves (AUC) were positively correlated (r = 0.71, p less than 0.05) to increased ethanol blood AUC values. Each subject's perception of ethanol intoxication was measured by use of a simple visual analog scale. Compared with placebo, verapamil significantly increased area under the effect versus time curve (10.19 +/- 7.6 to 13.83 +/- 7.81 cm.hr, p less than 0.002) but did not change the peak effect or time to peak effect. Ethanol effect versus concentration plots were not significantly different between verapamil and placebo treatment phases when increased ethanol concentrations during verapamil therapy were taken into account. The findings of our study suggest that verapamil significantly inhibits ethanol elimination, resulting in elevated blood ethanol concentrations that prolong the intoxicating effects of alcohol.

Adult↗
PubMed1992

Recombinant antigens in viral diagnosis.

DNA-fragments coding for a variety of different viral antigens have been cloned and expressed in E. coli. Selected purified recombinant antigens were used for detection of specific antibodies by the means of ELISA technique. This approach has been used for the development of four different ELISA's for the detection of HIV- and EBV-specific antibodies.

Antibodies, Viral↗
PubMed1992

Recombinant antigens in viral diagnosis.

DNA fragments coding for a variety of different viral antigens have been cloned and expressed in Escherichia coli. Selected purified recombinant antigens were used for detection of specific antibodies by means of the ELISA technique. This approach has been used for the development of four different ELISAs for the detection of HIV- and EBV-specific antibodies.

Antibodies, Viral↗
PubMed1991

Preoperative insurance status influences postoperative complication rates for gastric bypass.

One hundred morbidly obese patients who had gastric bypass surgery were studied to determine how various demographic and medical variables affected complication rates, weight loss, and reduction in comorbidities associated with obesity. During the follow-up period (range: 12 to 59 months), 42 patients developed at least 1 complication. Twenty-three patients developed postoperative medical complications, 9 developed psychiatric complications, and 24 developed complications related to food ingestion. No significant relationships were observed between outcome and age, sex, age of obesity onset, or associated medical disorders. Striking differences in outcome were noted, however, when patients were contrasted according to their preoperative insurance status. Patients dependent on medical assistance, social security disability, or workman's compensation (publicly funded group) (n = 40) developed significantly more medical and psychiatric complications than did those (n = 60) who had private medical insurance (p less than 0.02). Despite the higher complication rate, both groups had the same average weight loss (44.9 +/- 15.3 kg for the publicly funded group versus 43.1 +/- 12.9 kg for those with private insurance) and similar reductions in percent excess weight (66.0 +/- 18.4% versus 75.7 +/- 23.0%) during the first postoperative year. All patients also had similar reductions in medication requirements for hypertension, diabetes, and degenerative joint disease. Additionally, 45% of the publicly funded insurance group who either received public welfare (n = 26) or disability benefits (n = 14) preoperatively were able to attain either full-time or part-time employment postoperatively which allowed them to decrease their level of support (58% and 21%, respectively). Forty-six percent of women in the private insurance group who were not working outside the home also began part-time or full-time employment postoperatively. All patients who were working preoperatively continued to work. These data suggest that although the risks associated with gastric bypass surgery are greater in patients dependent on public funding, these patients benefit significantly from the surgery.

Adolescent↗
PubMed1991

Role of anaerobic bacteria in perimandibular space infections.

This review includes 44 patients with perimandibular space infections admitted to Johns Hopkins Hospital during a 5-year period. The most frequent spaces involved were the submandibular, peritonsillar, and parapharyngeal spaces. As expected, 1) peritonsillar abscesses were invariably associated with pharyngitis, 2) submandibular and buccal space infections generally represented complications of dental infections, and 3) parapharyngeal space infections were associated with both portals of entry. Most patients were treated with drainage procedures, and all received antimicrobial agents, the most common being penicillin. Serious complications included potential airway obstruction requiring tracheostomy in six patients with Fusobacterium bacteremia and two patients with septic emboli to the lung. All patients survived, and most had a relatively brief hospitalization with no sequelae.

Adult↗
PubMed1990

Resistance to the growth-promoting and metabolic effects of growth hormone in children with chronic liver disease.

Because growth failure is a frequent complication of chronic liver disease in childhood, we examined the growth hormone/insulin-like growth factor type I axis and its relationship to growth disturbances, nutritional status, and carbohydrate metabolism in nine children (2.1 to 18.6 years of age) with chronic cholestatic liver disease. Seven had cholestasis associated with splenomegaly and histologic findings of cirrhosis; two patients had Alagille syndrome. Stature was less than or equal to 15th percentile in all except the youngest subject and less than 5th percentile in five subjects. Ten-hour, nocturnal, integrated serum concentrations of growth hormone were considerably higher in patients with cholestasis than in control subjects (mean +/- SD) 9.7 +/- 3.8 vs 4.7 +/- 1.9 ng/ml; p less than 0.02). Serum concentrations of insulin-like growth hormone type I were less than 95th percentile confidence intervals for age- and sex-matched norms in five patients and at the lower limits of normal in the remaining four patients. Insulin sensitivity, determined with the minimal model intravenous glucose tolerance test, was not decreased in five patients despite elevated levels of circulating growth hormone. The estimated mean caloric and protein intake exceeded the recommended dietary allowance and the weight-for-height index was greater than 90% for six of nine patients. Triceps and subscapular skin-fold thicknesses, indicators of body fat stores, were greater than 25th percentile for five of nine and eight of nine patients, respectively, suggesting deficient lipolytic action of GH. We conclude that children with cholestatic liver disease have a resistance to the growth-promoting, diabetogenic, and lipolytic properties of growth hormone.

Adolescent↗
PubMed1990

Serodiagnosis of infectious mononucleosis by using recombinant Epstein-Barr virus antigens and enzyme-linked immunosorbent assay technology.

Four recombinant, diagnostically useful Epstein-Barr virus (EBV) proteins representative of the viral capsid antigen (p150), diffuse early antigen (p54), the major DNA-binding protein (p138), and the EBV nuclear antigen (p72) (W. Hinderer, H. Nebel-Schickel, H.H. Sonneborn, M. Motz, R. Kühbeck, and H. Wolf, J. Exp. Clin. Cancer Res. 7[Suppl.]:132, 1988) were used to set up individual enzyme-linked immunosorbent assays (ELISAs) for the qualitative and quantitative detection of immunoglobulin M (IgM) and IgG antibodies. In direct comparison with results obtained by standard immunofluorescence or immunoperoxidase assays, it was then shown that the recombinant EBV ELISAs provide the means for specific and sensitive serodiagnosis of infectious mononucleosis (IM) caused by EBV. The most useful markers in sera from such patients proved to be IgM antibodies against p54, p138, and p150. Additional positive markers for recent or ongoing IM apparently were IgG antibodies against p54 and p138. In contrast, anti-p72 IgG had a high preference for sera from healthy blood donors and, therefore, can be considered indicative of past exposure to the virus. Altogether, the individual ELISAs proved to be as specific and at least as sensitive for the diagnosis of IM as the currently available standard techniques are. Moreover, our findings suggest that, by combining individual test antigens, a workable ELISA system consisting of three assays (IgM against p54, p138, and p150; IgG against p54 and p138; and IgG against p72) can be established for the standardized rapid diagnosis of acute EBV infections.

Adolescent↗
PubMed1989

[Geriatric day clinics and rehabilitation].

If the present development of our population is not to result in a continued increase in care-requiring elderly people, the building and expansion of geriatric rehabilitation institutions is a matter of urgency. Numerous studies, some of which carried out in our own country, show how successful geriatric rehabilitation can be. Prerequisites are, apart from appropriately equipped facilities, the proper selection of those requiring care, adequate numbers of properly qualified personnel, and early initiation of any treatment needed. Thus, 70 to 80% of those originally scheduled for admission to an old persons' nursing home can be enabled to live more or less independently at home. Apart from geriatric hospitals, geriatric day clinics offer optimal possibilities for rehabilitation. They combine therapeutic effectiveness and economy with the advantage that, during treatment, the elderly person is not completely taken out of his familiar surroundings, which results in an improvement in his motivation to get well again quickly. At the same time, complicating diseases, such as, for example, diabetes mellitus, can be treated under conditions closely similar to those of the patient's subsequent day-to-day situation. In this sense, geriatric day clinics are not only desirable, but urgently needed institutions.

Activities of Daily Living↗
PubMed1989

Three-year growth and developmental follow-up of very low birth weight infants fed own mother's milk, a premature infant formula, or one of two standard formulas.

A cohort of 40 very low birth weight (VLBW) infants was followed until they reached 3 years of age. These infants were originally part of a feeding trial in the early postnatal period whereby they were fed either their own mother's milk, a standard whey-predominant formula, a casein-predominant formula, or a premature formula. Those fed the latter formula grew significantly better while in the hospital and had no biochemical derangements. At 3 years of age, there were no significant intergroup differences with respect to growth or development. There was a positive correlation between head growth in hospital and weight at 3 years, but there were no other significant relationships between early postnatal growth and growth parameters at 3 years. Socioeconomic status was the only predictor of developmental scores at 3 years of age. No adverse effects from early metabolic acidosis or alterations of amino acid profiles during the neonatal period were detectable at 3 years of age. However, the small sample size of this study may have missed true differences in outcome measures at 3 years, and larger studies are required to examine these questions further.

Cohort Studies↗