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Biomedical subjects

J Takala

Publications and source records attributed to J Takala.

At least 181 records · Page 10Linked to original sources
PubMed1990

Impaired utilization of exogenous amino acids after surgery for subarachnoid haemorrhage.

We studied the metabolic response to acute aneurysm surgery and its modification by parenteral nutrition. Forty-eight patients receiving perioperative corticosteroid treatment were randomly assigned to receive glucose alone (7.2 kcal/day, D5W + C), glucose and a conventional amino acid solution (7.2 kcal/day and 0.15 gN/day, CAA + C) or glucose and branched chain amino acid enriched solution (7.2 kcal/day and 0.14 gN/day, BCAA + C). Twenty patients without corticosteroid treatment received either glucose alone (7.2 kcal/day, D5W) or glucose and a conventional amino acid solution (7.2 kcal/day and 0.14 gN/day, CAA). Poor nitrogen utilization was indicated by strongly negative nitrogen balance in all groups and a failure of the infused amino acids to improve nitrogen balance. (Day 0; D5W + C: -9.3 +/- 3.6 g/day and CAA + C: -8.2 +/- 9.7 g/day vs CAA: -2.6 +/- 4.9 g/day, p less than 0.05, Day 1; D5W + C: -14.9 +/- 9 g/day vs CAA: -7.7 +/- 6.5 g/day, p less than 0.05, MANOVA). We conclude that subarachnoid haemorrhage and its surgical treatment induce a catabolic response and impaired utilization of exogenous nitrogen, further amplified by perioperative corticosteroids, which is in sharp contrast to the response to surgery not involving the central nervous system.

Adrenal Cortex Hormones↗
PubMed1990

Comparison of acceptance and performance of automated and manual data management systems in intensive care.

A computerized data management system for intensive care was compared to conventional manual record keeping. The criteria for the comparison were the nurses' acceptance, the reliability in recording haemodynamic trends and the ability of the physicians' to recall patient data after being on duty for 24 hours. At the time of the study the data management system had been in routine clinical use for 18 months. During the study the data management system was replaced by manual record keeping for three weeks. The majority of the nurses preferred the data management system to the manual record keeping. It was also more reliable in collecting data for trend graphs from the patient monitors. The physicians made significantly less mistakes in recalling patient data when the data management system was in use than during manual record keeping. According to the criteria of the study, the data management system was superior to the conventional manual system.

Computer Systems↗
PubMed1990

Effects of a very-low-calorie diet on metabolic control and cardiovascular risk factors in the treatment of obese non-insulin-dependent diabetics.

Ten obese non-insulin-dependent diabetics (six men, four women) with secondary drug failure were treated with a hypocaloric diet only (2100-3350 kJ/d) for 3 mo to assess the effects of weight reduction on metabolic control, energy production rate, and cardiovascular risk factors. During the 3 mo of follow-up the mean body weight decreased from 101.0 +/- 7.2 (means +/- SEM) to 87.2 +/- 5.5 kg (p less than 0.001). Basal energy production rate (kJ/min) decreased by 8.5%. Fasting blood glucose declined from 12.3 +/- 0.4 to 10.5 +/- 0.7 mmol/L (p less than 0.05) but mean diurnal glucose and glycosylated hemoglobin A1c did not change significantly. Serum total cholesterol was decreased at 2 wk but at 3 mo it did not differ significantly from the baseline value. A marked reduction was observed in serum triglycerides after 3 mo (4.57 +/- 1.0 vs 2.18 +/- 0.26 mmol/L, p = 0.012). The high-density lipoprotein (HDL) cholesterol increased after weight reduction (0.96 +/- 0.06 vs 1.11 +/- 0.05 mmol/L, p = 0.009). A significant decline was found in both systolic (152 +/- 6 vs 133 +/- 3 mm Hg, p = 0.004) and diastolic blood pressure (92 +/- 3 vs 81 +/- 3 mm Hg, p = 0.007). There was no evidence of linoleic acid deficiency after this diet.

Adult↗
PubMed1990

Respiratory and sleep patterns during nocturnal infusions of branched chain amino acids.

In the awake, normal subject, infusions of branched chain amino acids (BCAA) alter the ventilatory response to CO2. If this effect extends to the sleep state, it could contribute to our understanding of the neurophysiology of the sleep state as well as having clinical utility in ameliorating or preventing apnea syndromes. This study examined the effect of nocturnal BCAA infusion on sleep patterns (as measured by EEG, chest wall motion, Sao2 and end-tidal CO2) in five normal male subjects. Subjects were monitored with a polysomnograph from 21.00 to 7.00. Each subject was studied double-blind in random order on three occasions: a) baseline, no infusion (B); b) control, with normal saline infusion (S); and c) treatment, infusion of BCAA (BCAA). Sleep pattern analysis did not demonstrate any measurable effect of the BCAA infusion. End-tidal CO2 levels during BCAA infusion were lower than during baseline or control nights (mean +/- s.d.; BCAA: 5.8 +/- 0.7 kPa vs. B: 6.9 +/- 0.1 kPa, P less than 0.01 and S: 6.7 +/- 0.4 kPa, P less than 0.05). This study demonstrates that nocturnal BCAA infusions have effects on respiratory control during sleep; further clinical studies are required to determine whether these data have implications for disease states.

Adult↗
PubMed1989

Measurement of gas exchange in intensive care: laboratory and clinical validation of a new device.

The performance of a new gas exchange monitor was assessed both in laboratory simulation and in ICU patients. Laboratory simulation using N2 and CO2 injections resulted in a mean error of 2 +/- 2% in CO2 production (VCO2) and 4 +/- 4% in oxygen consumption (VO2) in respirator measurements (n = 55) and in a mean error of 3 +/- 2% in VCO2 and 4 +/- 2% in VO2 in canopy measurements (n = 25). The mean error in RQ during ethanol burning was 2 +/- 2% in respirator measurements (n = 45) and 1 +/- 1% in canopy measurements. FIO2 had little effect on the accuracy of VCO2, whereas the accuracy on high rates of VO2 (VO2 = 400 ml/min) was reduced, when FIO2 increased: the error ranged from 1 +/- 1% to 6 +/- 1%, except at VO2 400 ml/min during FIO2 0.8, where the error was 16 +/- 3%. Neither peak airway pressure (+13 to +63 cm H2O) nor PEEP (0 to +20 cm H2O) had an effect on the accuracy. The highest level of minute ventilation studied (22.5 L/min) reduced the accuracy slightly (mean error of VCO2 4 +/- 1% and VO2 7 +/- 2%). In patients during controlled mechanical ventilation, increasing FIO2 from 0.4 to 0.6 had no effect on the results. VO2 was consistently higher by gas exchange than by the Fick principle: 16 +/- 9% during controlled ventilation (n = 20), 21 +/- 8% on synchronized intermittent mandatory ventilation (n = 10) and 25 +/- 8% during spontaneous breathing. We conclude that the device proved to be accurate for gas exchange measurements in the ICU.

Analysis of Variance↗
PubMed1988

Effects of hypocaloric diet and insulin therapy on metabolic control and mechanisms of hyperglycemia in obese non-insulin-dependent diabetic subjects.

We studied the effects of hypocaloric diet (500 kcal/d) and insulin therapy in 15 obese (body mass index greater than 30.0 kg/m2) non-insulin-dependent diabetic patients with secondary drug failure and poor metabolic control. The patients were randomly allocated either to hypocaloric diet (n = 8) or to insulin treatment (n = 7). After 2 weeks of treatment there was a significant improvement in the fasting blood glucose, in the mean diurnal glucose, in glucosuria, and in glucose response to a 75-g oral glucose load in both groups. No change in insulin secretion was seen in either group. Glucose disposal rates (GDR) improved significantly both in the diet-treated group (from 2.34 +/- 0.15 to 4.01 +/- 0.40 mg/kg/min, P less than .01) and in the insulin-treated group (from 2.46 +/- 0.33 to 2.77 +/- 0.29 mg/kg/min, P less than .01). The improvement was greater in the diet-treated group (71%) than in the insulin-treated group (13%, P less than .05). The increase of GDR in the diet-treated group was due to an increase of nonoxidative GDR (from 1.18 +/- 0.17 to 2.98 +/- 0.39 mg/kg/min, P less than .001) as assessed by indirect calorimetry. In the insulin-treated group there was a small increase both in oxidative and nonoxidative GDR, but the changes were not statistically significant. Hepatic glucose output (HGO) in a postabsorptive state decreased significantly both in the diet-treated group (from 2.49 +/- 0.15 to 2.04 +/- 0.10 mg/kg/min, P less than .01) and in the insulin-treated group (from 2.63 +/- 0.23 to 2.05 +/- 0.12 mg/kg/min, P less than .01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

Changes in respiratory control induced by amino acid infusions.

We compared the metabolic and respiratory responses to a 4-h infusion of an amino acid solution consisting primarily of branched-chain amino acids (BCAA) to those after a standard amino acid solution in healthy subjects. Both the BCAA solution and the standard amino acid solution increased minute ventilation (mean increase 22%, p less than .001, and 18%, p less than .01, respectively), mean inspiratory flow (19%, p less than .01, and 19%, p less than .05) and oxygen consumption (9%, p less than .02, and 5%, NS). PaCO2 decreased (mean decrease 6%, p less than .01); there was a major increase in the ventilatory response to CO2 inhalation during administration of the BCAA solution but not the standard amino acid solution. Increased plasma norepinephrine concentration (mean increase 75%, p less than .001) during the infusion of the standard amino acid solution but not the BCAA solution suggested increased sympathetic activity. The results demonstrate augmented respiratory effects of amino acid infusions by BCAA enrichment, and a dissociation between the respiratory stimulation, metabolic rate, and sympathetic activity.

Adult↗
PubMed1988

Prevalence of exfoliation syndrome in Finland.

Three separate investigations are reported, covering a total of 795 patients from different parts of Finland, two of them consisting of inmates of old people's homes in two towns (N = 205 and 262) and one a randomly selected population from a rural commune (N = 328). They show the mean prevalence of exfoliation syndrome (PS) to be 14.2% in age group 60 less than or equal to 69 years, 21.9% in age group 70-79 and 34.7% in age group greater than or equal to 80. The prevalence increases statistically significantly with age. The mean prevalence of PS in all three groups was 22.4%. No isolate-like accumulation of PS could be demonstrated. The figures seem representative of the hole country.

Age Factors↗
PubMed1988

Diuretics and hyperuricemia in the elderly.

Serum uric acid (SUA) was studied in a rural population of 420 males and 592 females aged 65 years or more. The mean SUA concentration was 0.313 mmol/l in males and 0.316 mmol/l in females. In males, 47 (11.2%) and in females 60 (10.1%) had a SUA level of 0.42 mmol/l or more. Both the mean serum values and the frequency of hyperuricemia were higher than 11 years earlier in another, similar study. The SUA concentration was 0.361 mmol/l in the 435 individuals using diuretics and 0.281 mmol/l in the remaining 578. Of the 107 hyperuricemic individuals, 82% used diuretics, and only 2 out of those 20 where the SUA level was 0.50 mmol/l or more did not use diuretics. Apart from diuretics, only the serum creatinine concentration, the Body Mass Index, body weight and the hematocrit level were significantly associated with hyperuricemia in both sexes.

Aged↗
PubMed1987

Water, sodium and acid-base balance in premature infants: therapeutical aspects.

One of the main targets of fluid therapy in premature infants is to avoid variations in osmolality, which mainly means providing a stable sodium, glucose, and acid-base balance. Water, sodium, and acid-base balance were measured in 20 infants appropriate-for-gestational age with a gestational age less than or equal to 34 weeks. The infants were randomly assigned to one of two treatment groups. Fluid intake was restricted and air humidity in the incubator was high in order to minimize insensible water loss. Sodium intake in Group 1 was 2 mmol/kg/day and consisted of sodium chloride. Sodium intake in Group 2 was 4 mmol/kg/day and consisted of both sodium chloride and acetate. Weight loss was appropriate in both groups. In the high sodium intake group there was a tendency towards a more stable plasma sodium concentration than in the low sodium intake group. The use of sodium acetate was efficient and practical as normal acid-base balance was maintained. The protocol with restricted fluid intake (1st day 50 ml/kg, 2nd day 70 ml/kg, 3rd day 90 ml/kg, and 4th day 110 ml/kg), high air humidity, a sodium supply of 3 to 4 mmol/kg/day, and a slow correction of metabolic acidosis with sodium acetate, yields suitable guidelines in planning fluid and electrolyte therapy in premature infants less than or equal to 34 weeks' gestation.

Body Weight↗
PubMed1987

Stable glucose balance in premature infants with fluid restriction and early enteral feeding.

Hyperglycemia readily develops during intravenous glucose administration in premature infants. In this study glucose homeostasis was measured in 24 infants appropriate-for-gestational age with a gestational age between 27 and 34 weeks and a birthweight between 1,150 and 2,610 g. The infants were randomly assigned to one of two treatment groups. Fluid intake consisted of intravenous infusion of 5% glucose in Group 1 and 10% glucose in Group 2, and increasing amounts of human milk from the first day of life. The infants were treated in incubators with high air humidity in order to minimize insensible water loss and total fluid intake was restricted. The fluid restriction and early enteral feeding decreased the total amount of glucose given parenterally and thereby the risk of hyperglycemia. Glucose homeostasis was efficiently maintained in both groups and under the conditions described hydration by intravenous infusion of 5% and 10% glucose appear equally well tolerated.

Enteral Nutrition↗
PubMed1987

Nutrition in acute renal failure.

Nutrition is an integral part of supportive therapy of acute renal failure. Since ARF usually develops as a consequence of severe illness or injury, the metabolic changes due to failing kidney function are superimposed, often indistinguishably, on the metabolic effects of the primary disease. The majority of patients are hypercatabolic and may therefore become rapidly nutritionally depleted. The general principles of treatment are early dialysis, strict monitoring of vital functions, vigorous treatment of observed disorders, and metabolic monitoring and therapy. Use of enteral nutrition is rarely feasible and hence nutrition is given as TPN. The volume of fluid is not limiting for the application of TPN if adequate dialysis or continuous filtration methods are available. The TPN program of an average adult should contain daily approximately 35 to 40 kcal/kg of energy, given as both fat and glucose, and 1 g/kg of amino acids, given as both essential and nonessential amino acids, though the true requirements in ARF are unknown. The actual intakes of nutrients may have to be frequently adjusted according to the response of the patient.

Acute Kidney Injury↗
PubMed1986

Branched chain amino acid enriched parenteral nutrition in surgical intensive care patients.

The metabolic responses to branched chain amino acid enriched total parenteral nutrition were studied in surgical intensive care patients with documented severe catabolism. Twenty-four patients were randomised to receive total parenteral nutrition with either 50% (BCAA) or 15% (CONTROL) of its amino acid content as branched chain amino acids. The daily intake of nitrogen was 0.24 g per kg b. wt and that of energy, at steady state, 45 kcal per kg b. wt. Total parenteral nutrition resulted in similar nitrogen balances (Day 1 BCAA: -0.07 +/- 0.09, CONTROL: -0.05 +/- 0.10; Day 4 BCAA: -0.12 +/- 0.07, CONTROL: -0.06 +/- 0.09; Day 5 BCAA: -0.07 +/- 0.08, CONTROL: -0.05 +/- 0.08 g/kg b. wt day; mean +/- S.D.) in both treatment groups throughout the study. The urinary excretion of 3-methylhistidine was higher before feeding in the control group but the rates were similar during total parenteral nutrition in both groups. There were no differences between the groups in the decrease of serum prealbumin during the study. We conclude that the proposed benefits, if any, from enriching nutritional regimens with branched chain amino acids are unlikely to be of major therapeutic relevance in severe catabolism.

Journal Article↗
PubMed1985

Slow sodium acetate infusion in the correction of metabolic acidosis in premature infants.

The treatment of metabolic acidosis is one of many problems encountered in the premature infant during the first days of life. In this study, 11 infants with gestational ages of no more than 34 weeks were given sodium acetate as a continuous infusion from the first day of life. The daily sodium supply was set at 3 mEq/kg. The arterial serum pH was less than 7.30 in infants at the following ages: 1 to 3 hours, four; 24 hours, two; 48 hours, one; and 72 hours, one. The base deficit was calculated to be less than 5 in four infants at the age of 1 to 3 hours, in one infant at 24 hours, in one infant at 48 hours, and in no infants at 72 hours. The serum sodium concentrations were normal. The continuous infusion of sodium acetate seems to be suitable for the slow correction of metabolic acidosis, and the daily sodium supply of 3 mEq/kg gives a stable serum sodium concentration in the premature infant with a gestational age of no more than 34 weeks.

Acetates↗
PubMed1985

Failure of additional ketoanalogues of branched chain amino acids to improve the response to parenteral nutrition after experimental trauma in the rat.

The ketoanalogues of branched chain amino acids (KAA) may improve the post-traumatic protein metabolism. We studied the effects of additional KAA, supplied as a part of total parenteral nutrition (TPN), on liver protein synthesis and nitrogen balance in rats after standard surgical trauma. A TPN-regimen, containing 36 mmol/kg/day KAA and 58 mmol/kg/day amino acids was compared to an isonitrogenous (1.0 gN/kg/day) TPN-regimen containing 58 mmol/kg/day amino acids and no KAA in a 48 h experiment. The liver protein synthesis measured by perfusion with C14-leucine in vitro was similar in both groups 2 days after surgery (59.2 +/- 16.2 vs. 64.3 +/- 15.6 arbitrary units, mean +/- SD). The nitrogen balances were negative and of similar magnitude (-0.66 +/- 0.36 vs. -0.17 +/- 0.45 gN/kg/48 h, mean +/- SD). We conclude that TPN supplemented by high supply of KAA offers no systematic advantage over TPN alone after experimental surgical trauma.

Journal Article↗