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Biomedical subjects

J Sjölin

Publications and source records attributed to J Sjölin.

36 records · Page 2Linked to original sources
PubMed1993

Treatment of brain abscess with cefotaxime and metronidazole: prospective study on 15 consecutive patients.

The aim of the present investigation was to prospectively study the clinical and bacteriologic outcome of 15 consecutive patients with brain abscesses who were treated with surgical excision and cefotaxime (3 g every 8 hours) plus metronidazole (0.5 g every 8 hours) for at least 3 weeks. The patients were followed clinically and with computed tomographic (CT) examinations. All patients survived, and there were no recurrences within 1 year. CT scans showed an exponential decrease in the size of enhancement. Cultures of all six specimens obtained after < 24 hours of treatment with cefotaxime and metronidazole were positive compared with cultures of three of nine specimens obtained later (P = .017). Anaerobic bacteria were isolated from 2 of 3 patients given two doses of metronidazole or less compared with none of 12 given three doses or more (P = .029). Reversible side effects occurred in nine patients. It is concluded that cefotaxime plus metronidazole is an alternative treatment for brain abscess in addition to surgical excision because of their good abscess penetration, their ability to eradicate bacteria, and a good clinical outcome.

Adult↗
PubMed1993

Manipulation of the immunoinflammatory reaction in clinical sepsis.

For many years patients with sepsis and septic shock have been treated with antibiotics, fluids, surgery (if indicated) and, in the more severe cases, inotropic and ventilatory support. During recent years there has been an intensive development of new treatments based on increased knowledge of the pathophysiology. This presentation will focus on treatments modulating the immunoinflammatory response, which are either available in clinical practice today or which will be available in the near future. It is concluded that optimal therapy depends on the stage of the septic disease as well as the gram stain of the causative bacteria.

Adrenal Cortex Hormones↗
PubMed1993

Plasmapheresis in the treatment of primary septic shock in humans.

14 patients (mean age 25.5 yrs) with life-threatening primary septic shock were eligible for treatment with acute plasmapheresis in a prospective study. They had a short history of sepsis and had no severe underlying disease. 10/14 patients had systemic meningococcal disease. All patients were severely ill with a mean APACHE II score of 25.0. 12/14 patients were treated with plasmapheresis exchanging 1 plasma volume within hours of admission. 11/14 patients survived without major sequelae and 3 (21%) died of irreversible septic shock. This mortality is lower than that predicted from the APACHE II scores (55.2%). A subgroup of plasmapheresis-treated patients with septic shock and extensive petechiae were compared to a historical control group. The mortality in the treatment group was 1/7 (14%) versus 8/21 (38%) in the control group. We conclude that acute plasmapheresis may be a therapeutic option in the early stages of severe primary non-surgical septic shock.

Adolescent↗
PubMed1992

Immunity to and immunization against measles, rubella and mumps in patients after autologous bone marrow transplantation.

Humoral immunity to measles, rubella and mumps was studied in 63, 36 and 16 patients 1, 2 and 3 years, respectively after autologous bone marrow transplantation (ABMT). Serologic examination was performed using antibody-ELISA. One year after ABMT, 7/57 patients (12%) who were seropositive to measles before ABMT, became seronegative, 8/44 (18%) to rubella and 3/51 (6%) to mumps. Among patients who were retested at 2 and 3 years, three more patients became seronegative to measles, one to rubella, and three to mumps. Nine of 12 children who had previously been immunized against measles were seropositive before ABMT, 3/7 to rubella and 5/7 to mumps, respectively. After ABMT, 5/9 became seronegative to measles, none to rubella and 2/5 to mumps. Six seronegative children were immunized with a live trivalent attenuated measles, mumps, and rubella vaccine 1 to 2 years after ABMT. Two children seroconverted to measles, six to rubella, and four to mumps. No side effects were observed. Most adult patients who have had the diseases of measles, rubella, or mumps naturally remain seropositive, while children who have been immunized commonly lose their immunity after ABMT.

Adolescent↗
PubMed1991

Penetration of cefotaxime and desacetylcefotaxime into brain abscesses in humans.

Since clinical trials comparing the efficacies of different antibiotic regimens for treatment of brain abscesses are difficult to perform, the choice of antibiotics must rely on the antibacterial spectrum and the ability of the drug to penetrate into the abscess fluid. The aim of this investigation was to study the ability of cefotaxime and its active metabolite desacetylcefotaxime to penetrate into brain abscesses. Eight patients were given 3 g of cefotaxime intravenously every 8 h. Abscess fluid samples, obtained at surgery at various times after dosing, and blood samples were analyzed for their concentrations of cefotaxime and desacetylcefotaxime by using a newly developed microbiological assay. The brain abscess concentrations of cefotaxime and desacetylcefotaxime were 1.9 +/- 1.7 and 4.0 +/- 2.2 mg/liter, respectively. Simultaneous concentrations in plasma were 2.0 +/- 1.0 and 3.9 +/- 1.8 mg/liter, respectively. With increasing time following cefotaxime dosing there was a significant increase in the abscess:plasma concentration ratio of desacetylcefotaxime. Since both cefotaxime and desacetylcefotaxime penetrate well into the brain abscess, reaching concentrations above the MIC for probable bacteria except gram-negative anaerobes, it is concluded that cefotaxime in combination with metronidazole may be used as an alternative in the treatment of brain abscesses.

Adult↗
PubMed1991

High-dose corticosteroid therapy in human septic shock: has the jury reached a correct verdict?

Many studies have been published concerning high-dose corticosteroids (HDC) in septic shock. Most of them have been criticized for not adhering to methodologic standards. Four studies were published during the 1980s taking into consideration the criticism of previous trials. The general conclusion following these trials was the HDC should not be used in the treatment of septic shock. The aim of this review is to compare these trials as regards their aims, study design, results, and conclusions. The validity of the data presented is discussed. It is concluded that there is no unequivocal evidence that HDC is beneficial in septic shock, but it must be realized that there are tremendous difficulties in obtaining the true state of affairs in clinical trials regarding patients in septic shock. Accumulated data indicate that HDC, given as one single dose during the initial hours of gram-negative septic shock, more likely than not has a beneficial effect on mortality.

Adrenal Cortex Hormones↗
PubMed1990

Total and net muscle protein breakdown in infection determined by amino acid effluxes.

The present investigation was undertaken to study whether, in human infection of varying severity, peripheral 3-methylhistidine efflux and urinary excretion are associated with net protein degradation and to estimate the protein synthesis rate from the combined effluxes of 3-methylhistidine, tyrosine, and phenylalanine. Quadruplicate femoral arteriovenous differences of 3-methylhistidine, tyrosine, and phenylalanine were multiplied by leg plasma flow in 15 infected patients. Leg effluxes for 3-methylhistidine, tyrosine, and phenylalanine were -0.074 +/- 0.011, -2.57 +/- 0.43, and -3.17 +/- 0.44 mumol/min, respectively. There was a significant linear relationship (P less than 0.01) between the effluxes of tyrosine and phenylalanine and the efflux and urinary excretion of 3-methylhistidine. A significant release of tyrosine and phenylalanine was observed in patients studied at the 3-methylhistidine level seen in normal healthy subjects. It is concluded that in infection 1) there is an increased breakdown of skeletal muscle protein and a reduced rate of protein synthesis, with the latter being relatively more important in patients with mild disease; and 2) urinary 3-methylhistidine excretion is associated with net skeletal muscle protein degradation for the patient group studied.

Abdomen↗
PubMed1989

Splanchnic and peripheral release of 3-methylhistidine in relation to its urinary excretion in human infection.

The present investigation was undertaken in order to determine the release of 3-methylhistidine (3MH) from the splanchnic region and from the leg, and the contributions these make to the increase in urinary 3MH excretion in infection. Thirteen febrile patients with infection were investigated. After an overnight fast, hepatic vein, femoral vein, and radial artery catheterizations were performed. Splanchnic and leg blood flows were determined by dye dilution technique. Plasma 3MH was analyzed by a modified HPLC method. The release of 3MH from the leg was 0.064 +/- 0.007 mumol/min (+/- SE) and from the splanchnic region 0.012 +/- 0.013 mumol/min. These releases of 3MH constitute 27% +/- 2% and 8% +/- 6% of the individual urinary excretions, respectively. With increasing degree of catabolism, measured as individual 3MH increase above baseline excretion or as the 3MH to creatinine ratio (3MH:Cr), the relative contribution to urinary excretion from the leg was increased (individual increase, P = 0.08; 3MH:Cr, P less than 0.01). Since this contribution was not decreased in the more catabolic patients, as would have been expected if the increase in urinary 3MH originated elsewhere, it is concluded that skeletal muscle is the source, and these results thus validate the use of urinary 3MH excretion as a marker of myofibrillar protein catabolism in infected patients.

Adult↗
PubMed1989

Evaluation of urinary 3-methylhistidine excretion in infection by measurements of 1-methylhistidine and the creatinine ratios.

When 3-methylhistidine (3MH) excretion is used as an indicator of myofibrillar protein catabolism, there are restricting factors, such as meat intake, incorrect 24-h urine collections, and a large interindividual variation in basal excretion. 1-Methylhistidine (1MH) was previously suggested as an indicator of meat intake. We studied the basal urinary excretion of 1MH and whether this was influenced by infection and we compared the use of 3MH vs the 3MH:creatinine ratio (3MH:Cr) in detecting changes during infection. The basal excretion of 1MH was 84.9 mumol/24 h and its creatinine molar ratio (1MH:Cr) was 7.4 x 10(-3) with no change during infection. Because 1MH:Cr was significantly increased in 4 of 14 patients, their 3MH values were considered influenced by meat intake and thus discarded. Among the remaining 10 patients, 9 showed a significant individual increase in 3MH:Cr during infection compared with only 4 in 3MH. This was due to a higher precision in 3MH:Cr despite the concomitant significant increase in urinary creatinine excretion.

Adolescent↗
PubMed1989

Exchange of 3-methylhistidine in the splanchnic region in human infection.

This investigation was undertaken to determine the splanchnic exchange of 3-methylhistidine (3MH) in infection. Hepatic vein, femoral vein, and radial artery catheterizations were performed in 12 febrile patients with infections of varying severity. Differences in arteriovenous 3MH, analyzed by high-performance liquid chromatography, were multiplied by the plasma flows, determined by a dye dilution technique. The mean splanchnic efflux was 0.062 +/- 0.180 mumol/min (mean +/- SD) with uptake occurring in five patients. The splanchnic uptake was significantly (p less than 0.001) correlated with the urinary 3MH excretion and the peripheral release from the leg. It is concluded that in human infection, splanchnic 3MH release is low and in patients with high rates of myofibrillar catabolism there may even be an uptake. The urinary 3MH excretion is still a marker of myofibrillar protein breakdown because it correlates well with the release from the leg, regardless of whether the patient has a splanchnic uptake or a release.

Chromatography, High Pressure Liquid↗
PubMed1989

Chemiluminescence of polymorphonuclear leukocytes and whole blood during acute bacterial infection.

The purpose of this study was to follow the changes in oxidative metabolism of polymorphonuclear leukocytes (PMN) and whole blood, during and after an acute bacterial infection, in otherwise healthy individuals, with the hypothesis that the majority of the subnormal activities found at clinical investigation of PMN functions in this respect, as part of the investigation of individuals with increased susceptibility to bacterial infections, is explained by subclinical infections or consequences of recent infections. 10 patients were followed from the day of admission and up to 80 days after the acute illness. Luminol- but not lucigenin-enhanced chemiluminescence (CL) of PMN was increased during the febrile period and normalized in parallel with normalization in body temperature. Both luminol- and lucigenin-enhanced CL were enhanced in whole blood during the period of fever. Subnormal activities of luminol- or lucigenin-enhanced CL were only seen sporadically. We conclude that the oxidative metabolism of PMN, as measured by lucigenin-enhanced CL, is virtually unaffected cause of the increased luminol-enhanced CL during the acute illness is suggested to be due to the increase mobilization of myeloperoxidase.

Acridines↗
PubMed1987

Urinary excretion of 1-methylhistidine: a qualitative indicator of exogenous 3-methylhistidine and intake of meats from various sources.

In order to investigate whether the urinary excretion of 1-methylhistidine (1MH) might serve as an objective indicator of meat ingestion and exogenous 3-methylhistidine (3MH) intake, healthy subjects were fed an ovolactovegetarian diet. At five-day intervals they were given meat of different origin and 24-hour urinary excretions of 1MH and 3MH were determined. After beef intake there was a marked increase of 3MH and 1MH excretion. The elimination curves were found to follow first-order kinetics and to indicate similar elimination rates. 1MH was present in ten different types of meat analyzed. A strong linear relationship was found between increase in 3MH and 1MH excretion and the amount of chicken, pork, or plaice ingested. IMH may serve as an objective indicator of meat and exogenous 3MH intake, since it is present in meat, and, regardless of source, shows similar dose-independent kinetics, and has similar half-life to 3MH.

Adult↗
PubMed1985

Post-operative substrate utilisation and gas exchange using two different TPN-systems: glucose versus fat.

Twenty patients were studied over the first 4 post-operative days following abdominal aortic surgery. Ten patients had 93% of their non-protein energy as glucose and insulin was given to keep blood glucose below 10 mmol/l. The other 10 patients had 80% of non-protein energy as fat (Intralipid). Amino acids corresponding to 12 g of nitrogen were given in both groups. Gas exchange, nitrogen balance, phosphate balance, vanillylmandelic acid (VMA) excretion, 1- and 3-methylhistidine in urine, acute phase proteins, immunoglobulins and albumin were followed. Substrate utilisation was calculated from indirect calorimetry data and nitrogen excretion. Metabolism in the early post-operative phase was found to adapt to the nutrition regimen given even though the composition was extreme either in fat or carbohydrate content. The glucose-insulin regimen had a better nitrogen sparing effect and based on the difference in 3-methylhistidine excretion it is suggested that mainly protein muscle benefitted from this. Regardless of the TPN-regimen given, those patients whose RQ deviated the most from the average in their group had the highest nitrogen excretion. The two groups showed no differences in plasma proteins and catecholamine excretion.

Journal Article↗
PubMed1983

Great interindividual insulin dependent variation in ketone body metabolism in human infection.

In an effort to study whether previous data obtained from animal studies showing decreased blood ketone body concentration and suggesting a shut-off of ketone body production in acute infection are valid also for man, 14 previously healthy patients, suffering from pyelonephritis, pneumonia, serous meningitis or upper respiratory tract infection were investigated. There were great interindividual differences in the ketone body response, which seems to be insulin dependent. The results indicate that in man there is probably no general inhibition of ketone body production in the liver in acute infection.

Adolescent↗