[Prolonged parenteral nutrition with the BROVIAC catheter].
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Adult↗
Biomedical subjects
K Ladefoged
Publications and source records attributed to K Ladefoged.
[Parenteral nutrition--indications and complications].
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Humans↗
Autoantibodies and serum immunoglobulins in chronic liver diseases.
In a prospective consecutive study, 68 patients with various liver diseases and 67 control persons were examined for the occurrence of smooth muscle antibodies (SMA), antinuclear antibodies (ANA) and mitochondrial antibodies (MTA) of IgG, IgA and IgM class. A determination of serum immunoglobulins (S-IgG, S-IgA and S-IgM) was also performed. IgG-SMA in titres of greater than 80 occurred in 8 of 12 patients (67%) with hepatitis B antigen (HBag)-negative chronic active liver disease (CALD) and not in other diseases. Apart from one patient with primary biliary cirrhosis (PBC), IgG-ANA in titres of greater than 40 were likewise detected only in HBag-negative CALD (33%). The titres of IgG-SMA and IgG-ANA varied analogously with the biochemical liver parametres. There was a mutual exclusion between HBag and IgG-SMA/-ANA in titres of greater than 20, while IgM-SMA occured in titres of 80 in two patients with HBag-positive CALD. The incidence and titres of IgM-SMA and -ANA were not higher than in the controls. IgA-SMA and -ANA were detected only sporadically. The MTA demonstrated were of IgG PCLASS AND TITRES OF GREATER THAN 40 WERE FOUND ONLY IN PATIENTS WITH PBC (4 of 5). Som of the patients in all groups had an increased conenctration of one or more of the serum immunoglobulins. S-IgG levels were found to be significantly higher in CALD than in the other groups
Adolescent↗
Fluid and electrolyte absorption and renin-angiotensin-aldosterone axis in patients with severe short-bowel syndrome.
In eight patients who had received long-term parenteral nutrition because of short-bowel syndrome the need for parenteral supply of fluid, sodium, and potassium was estimated by balance studies. Six patients had jejunostomies. In two, most of the colon was preserved. Jejunostomy patients had a huge stool mass (1710--5270 g, median 2530 g/day) with fixed concentrations of sodium (92 +/- 10 mmol/l) and potassium (15 +/- 4 mmol/l). In contrast, two patients with massive small-bowel resection but with more than half of the colon intact showed almost normal sodium absorption and considerably smaller stool mass (170--510 g/day). Despite apparently good health and normal plasma electrolytes, urea, and haematocrit, four of six jejunostomy patients were sodium-depleted with low plasma volume, low sodium excretion in the urine, and increased plasma renin activity and, in the three most severe cases, increased aldosterone. Even in case of sodium depletion the sodium loss from jejunostomy effluents remained high and presumably unaffected by salt-retaining hormones. The study confirms the importance of preservation of part of the colon for maintenance of fluid and electrolyte balance in patients with extensive bowel resection. Jejunostomy patients who are eating normally may need large parenteral saline supply. Assessment of water and electrolyte homeostasis in these patients requires determination of the urinary sodium excretion and is supported by measurements of plasma renin activity and plasma aldosterone concentration.
Adult↗
Correlation between serum immunoglobulin concentrations and smooth-muscle antibodies in acute viral hepatitis.
Smooth-muscle antibodies (SMA) were investigated by the indirect immunofluorescence method and serum immunoglobulin (Ig) concentrations measured by radial immunodiffusion in 15 patients with hepatitis B antigen (HBAg)-positive and 20 patients with HBAg-negative acute hepatitis. In both types of hepatitis the serum IgM and IgG concentrations were significantly higher than in 55 controls, while the IgA levels were the same in patients and controls. IgM-SMA in titres of 10--80 occurred in 11 (55%) patients with HBAg-negative acute hepatitis, and this was significantly higher than in controls (P = 10(-8), whereas IgM-SMA were found in only 2 (13%) patients with HBAg-positive acute hepatitis. IgG-SMA occurred in 3 (15%) HBAg-negative and in 4 (27%) HBAg-positive patients. In HBAg-negative hepatitis the serum IgM concentrations were significantly higher in IgM-SMA-positive (mean: 439 mg/dl) than in IgM-SMA-negative (mean: 216 mg/dl) cases (P = 0.028). It was not possible to demonstrate a similar rleationship in HBAg-positive acute hepatitis. No correlation between the occurrence of IgG-SMA and the IgG levels could be demonstrated in acute hepatitis. It is assumed that IgM-SMA may account for a minor part of the elevated IgM levels in HBAg-negative acute hepatitis, but the reason for formation of SMA in acute viral hepatitis is not known.
Acute Disease↗
Long-term parenteral nutrition.
Nineteen patients (11 women and eight men) aged 20-68 received long-term parenteral nutrition, mostly at home, for six to 63 months (mean 19 months). Indications for LTPN were extensive, active Crohn's disease in three patients, intestinocutaneous fistulas in three, and short-bowel syndrome in the remaining 13 patients. Subclavian or intra-atrial (Broviac) catheters were most commonly used, for which the average life was four and seven months respectively. Complications of long-term parenteral nutrition included pneumothorax in four out of 48 subclavian vein punctures. Catheter-induced thrombosis of central veins was shown by phlebography 17 times in nine patients, and eight episodes of total occlusion occurred. Two of these patients had pulmonary infarction. Nineteen episodes of catheter sepsis occurred in 11 patients, but only one was fatal. Complications related to intestinal disease included intra-abdominal abscesses and intestinal fistulas, and disturbances of liver function. Five patients died, though in only two was death related to long-term parenteral nutrition. One of these patients died from catheter sepsis, the other had subdural haematoma possibly caused by anticoagulant treatment. Eight of the 14 surviving patients still needed parenteral nutrition. All received a disability pension, but six had an acceptable quality of life with almost normal social activities.Despite problems such as difficulties in maintaining standardised infusion programmes, it was concluded that long-term parenteral nutrition at home is practicable and consistent with an acceptable quality of life.
Adult↗
Distribution of pellets in the gastrointestinal tract. The influence on transit time exerted by the density or diameter of pellets.
The influence on transit time exerted by the density or diameter of pellets has been established in six ileostomy subjects. An increase in density from 1.0 to 1.6 significantly increased the average transit time of pellets in the small intestine. The average transit time for the light and heavy pellets being 7 and 25 h respectively. The diameter of pellets is of minor significance. The findings suggest the use of density as a means of modifying the period of absorption of controlled-release pellets.
Adult↗
Studies of smooth-muscle antibodies in acute hepatitis.
Smooth-muscle antibodies (SMA) of the IgG and IgM class in titres of 10 to 80 were demonstrated in 19 of 38 patients with acute hepatitis (50 per cent). No IgA-SMA were detected. IgM-SMA occurred in the beginning of the disease, while IgG-SMA were found both early and late in the course of disease. There was no correlation between the occurrence of SMA and the biochemical liver parameters or the mode of exposure to infection, but IgM-SMA were found more often in the first serum sample obtained from patients without hepatitis-B-associated antigen (HBAg) than in HBAg-positive patients (P1 + P2 = 0.04) and it is suggested that hepatitis virus A more readily than hepatitis virus B can elicit the formation of SMA. The mean PHA-induced lymphocyte-transformation response was significantly lower in hepatitis patients than in the controls (0.02 greater than p greater than 0.01). The lymphocyte-transformation response to a low PHA dose (1 mug per ml) was lower in hepatitis patients without SMA than in those with SMA (0.10 greater than p greater than 0.05). SMA were not found in 28 control persons, and the incidence of tissue antibodies other than SMA did not differ in hepatitis patients and controls.
Acute Disease↗
Lymphocyte transformation test with liver-specific protein and phytohaemagglutinin in patients with liver disease.
Lymphocytes from thirty-four untreated patients with various liver diseases were stimulated in a lymphocyte transformation test with liver-specific protein (LSP). Eight of ten patients with chronic active or persistent hepatitis, two of five patients with non-alcoholic cirrhosis and six of nineteen patients with acute hepatitis showed a positive in vitro reactivity to LSP. In a control group of twelve persons without evidence of liver disease, eleven gave a negative response to LSP stimulation, whereas one person showed a positive response. Among fourteen patients with chronic hepatitis or non-alcoholic cirrhosis treated with prednisone at the time of the investigation, only one showed reactivity to LSP stimulation. Three patients in this group had previously had a positive reaction before prednisone was given. There was no statistically significant correlation between the reactivity to LSP stimulation and the presence or absence of hepatitis-associated antigen (HBAg) in serum, or with the biochemical liver parameters. The response to in vitro stimulation with phytohaemagglutinin (PHA) was found to be significantly lower as compared with the control group in eleven patients with alcoholic liver disease and in the patients with acute hepatitis who had HBAg in serum. This decrease in reactivity could apparently not be ascribed to immuno-suppressive factors in the patients' sera.
Acute Disease↗
The concentration of ketone bodies, free fatty acids, and glycerol in the blood of obese perons after injection of insulin and glucose. Studies before and during absolute fasting.
The blood patterns of acetoacetate (AA), 3-hydroxybutyrate (3-HB), free fatty acids, and glycerol were registered after intravenous injection of insulin or glucose in seven obese persons. In each individual investigated the study with insulin was carried out first and that with glucose 2 days later. Both sets of studies were repeated after 8 and 10 days of absolute fasting. In the studies both before and during fasting the concentration of AA and 3-hb in blood varied independently of lipolysis. It is concluded that determination of only one of the ketone bodies is an insufficient expression for changes in total ketone body concentration ana that the peripheral metabolism of AA during the fasting studies was less than the production of AA after injection of insulin or glucose, whereas the opposite was the case in the prefasting studies.
Acetoacetates↗
Experience with once daily dosing of gentamicin: considerations regarding dosing and monitoring.
Plasma concentrations of gentamicin following a fixed dose of 240 mg once daily to patients with normal renal function were measured. The purpose was to establish guidelines to achieve a sufficiently high peak concentration with an appropriately low risk of accumulation. In 40 patients, 1-hour concentrations of plasma gentamicin had a median of 9.3 mg/l (range: 4.5-19.0 mg/l) and 9.7 mg/l (range: 3.6-14.6 mg/l) on days 1 and 3 of gentamicin treatment, respectively. Thirty-nine patients had 1-hour concentrations > 5 mg/l. The 1-hour concentrations varied considerably intra- and interindividually but showed a significant inverse correlation with body weight, surface area and the estimated endogenous creatinine clearance. The plasma gentamicin elimination half-life correlated significantly with age and inversely with body weight and creatinine clearance. There was no increase in the mean plasma creatinine from day 0 to day 4. No patients showed signs of nephrotoxicity, although 2 patients, both elderly and with low body weight, showed signs of beginning gentamicin accumulation. In conclusion, gentamicin treatment with the dose of 240 mg once daily in 3 days to adults with normal kidney function generally does not require adjustment or monitoring. However, the dose should be increased in young patients with an excessive body weight, and decreased doses are needed for old and underweight patients. Monitoring of trough plasma gentamicin concentration is not necessary with treatment duration of 3 days or less.
Adult↗
Quality of life in patients on permanent home parenteral nutrition.
A psychosocial survey of patients on permanent home parenteral nutrition (HPN) has been made to assess the quality of life in these patients. All patients on permanent HPN in the period August 1978 to August 1979, including 7 women and 6 men, age range 24-62 yr (median 53) were interviewed, as well as partners of 11 patients who were married or cohabiting. The duration of HPN ranged from 2-43 mon (median 24 mon). They were asked specific questions about physical symptoms, social and leisure activities, interpersonal relationships, sexuality, psychological problems, and feelings about HPN. None had an outside job, but 6 (46%) did most of the housekeeping. Some physical distress was recorded in almost all patients, but 9 (69%) considered themselves healthy or fairly healthy, whereas 4 (31%) felt diseased. Social and leisure activities were normal or only slightly impaired in most. Sexual activity had ceased completely in 5 above 55 yr, in association with onset of the disease; younger patients displayed normal and unchanged sexual activity. Psychological symptoms were recorded in 6 (46%), major symptoms in 4 (31%). Seven partners considered HPN to be a moderate or severe burden, mainly psychological changes in the patient that caused marital tension in 3 cases. Criteria for quality of life were: 1) no major physical distress, 2) no major psychological symptoms, 3) no substantial restriction of social and leisure activities, 4) ability to accept HPN, 5) overall satisfaction with conditions of life. Nine patients who fulfilled at least 3 of these criteria were considered to have a fair quality of life, 4 who complied with less than 3 of the criteria a poor quality of life. The interviews were repeated at intervals of 6-10 mon in 9 patients, and revealed no systematic improvement or deterioration of quality of life during HPN.
Adult↗
The effect of selenium supplementation on skeletal and cardiac muscle in selenium-depleted patients.
BACKGROUND: The purpose of the present study was to evaluate the effect of sodium selenite on skeletal and cardiac muscular function in patients with severe Se deficiency. METHODS: Skeletal and cardiac muscular function was investigated in 10 selenium depleted patients on long-term home parenteral nutrition because of short bowel syndrome. The following examinations were applied: Skeletal muscle biopsy, muscular force test (Kin-Com dynamometer test), electromyography (EMG) and radionuclide ventriculography. The patients were blindly randomized to intravenous supplementation with selenium 200 micrograms 5 to 7 times per week or placebo for 4 months. Hereafter the examinations were repeated. The patients randomized to placebo received selenium in an open study for a further 4 months and hereafter their skeletal and cardiac function was reevaluated. RESULTS: Plasma selenium increased to normal levels from median .21 mumol/l (range 0-.69) to 1.25 mumol/l (range .9-2.27) following selenium repletion. The muscle biopsies showed only minor abnormalities. The only change after selenium supplementation was a small but statistically significant increase of the mean diameter of fiber type 1. The muscle strength of the quadriceps muscle was unchanged after selenium substitution. EMG did not reveal signs of myopathy. The cardiac function was normal and remained unchanged. CONCLUSION: Despite severe selenium depletion ten patients on long term home parenteral nutrition had normal cardiac function, and no clinically significant signs of skeletal myopathy. The only change after selenium supplementation was a small but statistically significant increase of the mean diameter of muscle fiber type 1.
Adult↗
The metabolism of [75Se]selenite in patients with short bowel syndrome.
BACKGROUND: Patients on home parenteral nutrition (HPN) require significantly higher amounts of selenium compared with controls. The purpose of the present study was to investigate if selenium deficiency of patients with short bowel syndrome is caused by selenium malabsorption or by excessive intestinal or renal loss. METHODS: The metabolism of [75Se]selenite was investigated in eight selenium-depleted short bowel patients on HPN and in six control subjects. The isotope was given orally, and in a subsequent study as bolus injection or as 12-hour IV infusion. RESULTS: The fractional intestinal absorption of selenium was significantly reduced in the patients (2% to 58%, median 20%) when compared with the reference group (79% to 91%, median 82%) (p < .001). Within the group of patients we found a positive significant correlation between fractional selenium absorption and the length of the remaining small intestine (r = 0.95, p < .05). After parenteral [75Se]selenite administration, the patients showed a significantly higher fecal loss and a significantly reduced urinary excretion of 75Se when compared with the controls. Bolus injection vs 12-hour infusion of [75Se]selenite did not affect the cumulative fecal or urinary 75Se excretion in the HPN patients. CONCLUSIONS: Reduced intestinal selenium absorption is probably the most important cause of the selenium deficiency reported in patients with short bowel syndrome, but increased endogenous intestinal selenium loss and low selenium intake may also contribute. Despite the renal counterregulation, which results in a low urinary selenium excretion, HPN patients need a supply of selenium with their parenteral nutrition.
Adult↗