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Biomedical subjects

K V Kuhlemeier

Publications and source records attributed to K V Kuhlemeier.

35 records · Page 2Linked to original sources
PubMed1985

Prophylactic antibacterial therapy for preventing urinary tract infections in spinal cord injury patients.

We conducted 202 trials in 161 male hospital patients to determine if prophylactic administration of ascorbic acid or antibacterials (trimethoprim-sulfamethoxazole, nalidixic acid, methenamine hippurate or nitrofurantoin macrocrystals) would prevent bacteriuria infections in spinal cord injury patients who had had at least 1 bout of bacteriuria. None of the drugs tested appeared to be statistically effective in the doses used in preventing bacteriuria in these patients. Moreover, sensitivities were lost to several drugs other than those used prophylactically. We conclude that use of prophylactic doses of ascorbic acid or antibacterials has not proved to be beneficial in spinal cord injury patients free of indwelling catheters.

Anti-Infective Agents, Urinary↗
PubMed1985

Effective renal plasma flow: clinical significance after spinal cord injury.

We conducted a study to determine if effective renal plasma flow routinely measured by hippurate clearance during a comprehensive renal scintillation procedure is a relevant measure for assessing renal function in spinal cord injury patients. All subjects had spinal cord injury and had had contemporaneous comprehensive renal scintillation procedures and excretory urograms on 2 occasions 24 months or less apart. Each of the 469 kidneys was placed into 1 of 5 quintiles on the basis of its effective renal plasma flow at the first examination. The percentage of the kidneys that had clinically significant pyelocaliectasis or in which the pyelocaliectasis significantly worsened was 20.4 per cent in the lowest (first) quintile and 9.3, 2.2, 5.4 and 3.2 per cent in the second, third, fourth and fifth quintiles, respectively. Analogous data for ureterectasis were 16.1, 8.2, 2.2, 3.3 and 3.2 per cent. There was a significant (p less than 0.01) correlation between effective renal plasma flow and renal parenchymal thickness. Kidneys with renal calculi averaged effective renal plasma flows about 25 per cent lower than those of kidneys free of calculi. We conclude that effective renal plasma flow is a relevant measure for assessing renal function in spinal cord injury patients.

Acute Disease↗
PubMed1984

Effect of skeletal muscle relaxants on bladder smooth muscle.

The present study was conducted to determine the effects of skeletal muscle relaxants on contractions of bladder smooth muscle. Rat, rabbit and human bladder muscle strips were incubated in a 50 ml. organ bath filled with physiological salt solution, aerated with 95 per cent O2, 5 per cent CO2 and maintained at 37C. Contractions were induced both electrically and with acetylcholine. Contractile strength was measured before and after 30 to 70 minute incubations with diazepam (0.25 to 1.0 microgram./ml.), dantrolene sodium (4 micrograms./ml.) or baclofen (4 micrograms./ml.). Neither baclofen nor dantrolene sodium had any effect (p greater than 0.3) on electrically or acetylcholine-induced contractions in any of the 3 species tested but diazepam potentiated both electrically induced (115 per cent of predrug contractile strength, p less than 0.05) and acetylcholine-induced (122 per cent of predrug contractile strength, p less than 0.01) contractions of rat, but not rabbit or human, bladder muscle. In rabbits diazepam significantly reduced maximal bladder pressures in vivo (p less than 0.05) but had no effect on bladder capacity. Dantrolene sodium had no effect on rabbit bladder pressure or capacity in vivo. While diazepam is thought to exert its effects on skeletal muscle through CNS inhibition, these results suggest that diazepam may affect rat but not rabbit or human bladder smooth muscle directly.

Acetylcholine↗
PubMed1984

Renal function after acute and chronic spinal cord injury.

Computer-assisted renal scintigraphy was performed on 160 acute and 240 chronic spinal cord injury patients, and 287 noninjured controls. Concurrently, measurements of global and individual kidney effective renal plasma flow, time of maximum activity in each kidney, ratio of maximum counts to the counts at 27 minutes after injection over each kidney and number of counts in each kidney at 1 to 2 minutes after injection were made. The time of peak activity over the kidney and differential function at 1 to 2 minutes after injection were not affected significantly by age, sex or spinal cord status. Global and individual effective renal plasma flows were significantly affected by all of these factors. Both plasma flow measures generally were higher for male than for female patients. Effective renal plasma flow decreased steadily after early adulthood and, except for the youngest and oldest patients, values were lower for spinal cord injury patients than for normal controls. The ratio of peak to 27-minute counts was affected significantly by age and spinal cord injury but not by sex. In patients without obvious pathological conditions followup scintigrams 1 to 3 years after injury showed no significant changes owing to interval since injury on any parameter studied. Lower limits of basal scintigraphic parameters are given for evaluation of renal status in neurologically intact or spinal cord injury persons.

Adolescent↗
PubMed1984

Serum creatinine as an indicator of renal function after spinal cord injury.

This study was conducted to determine (1) if serum creatinine levels (SCL) in spinal cord injury (SCI) patients are influenced by neurologic level of lesion, sex, age, or time since injury, and (2) if SC values are a sensitive indicator of renal function (as reflected by renal plasma flow [RPF]) in these patients. The overall SC mean and SD were 0.9 +/- 0.2mg/dl (n = 141). There was no difference in SC values between patients with higher injuries (T-6 or above) and patients with lower injuries (T-7 or below), nor was there any difference between patients with lesions less than 3 months, 10-14, 22-26, 34-38, 46-50, or 58-62 months in duration. Age and gender each accounted for less than 5% of the variation in SC. There was no significant correlation between RPF and SC (unless the patient also had moderate or severe pyelocaliectasis) nor between change in serum RPF (from the previous examination, usually 12 months earlier) and change in SC, suggesting that SCL does not reflect the functional status of the kidney in these patients.

Adolescent↗
PubMed1983

Failure of antibody-coated bacteria and bladder washout tests to localize infection in spinal cord injury patients.

The validity of the antibody-coated bacteria test and Fairley washout procedure to determine whether urinary tract infections were of kidney or bladder origin in spinal cord injury patients was assessed by comparing test results with those obtained from culture of ureteral urine specimens. It was concluded that neither the presence of antibody-coated bacteria nor a positive bladder washout test can be considered as definitive evidence that bacteriuria is of renal origin in these patients.

Antibody-Coated Bacteria Test, Urinary↗
PubMed1983

Prescriptive arm ergometry to optimize muscular endurance in acutely injured paraplegic patients.

This study compared the effect of (1) continuous, (2) intermittent, and (3) graded exercise on the cardiopulmonary responses of 12 acutely injured paraplegic individuals having neurologically complete spinal lesions, between T7 and T12, and seven able-bodied control subjects. Continuous exercise consisted of cranking an arm ergometer at a constant rate of 30W. Intermittent exercise consisted of arm ergometry at 60W for 30-second periods interspersed with 30-second rest periods. In graded exercise, subjects worked for consecutive two-minute periods at rates of 10, 20, 30, 40, and 50W with no rest periods between work periods. Subjects exercised for 10 minutes or until they reached subjective fatigue. Heart rate (HR) and oxygen consumption (VO2) were measured during rest and work. Paraplegic subjects performed 4.93, 4.89, and 4.95 watt-hours of continuous, intermittent, and graded exercise respectively. Comparable figures for control subjects were 4.98, 4.91, and 4.96 watt-hours. There was a high degree of correlation between HR and VO2 in both paraplegic (r = 0.80) and normal (r = 0.85) subjects. Both VO2 and HR were highly correlated with work load in each group. Paraplegic subjects had significantly higher HRs (p less than 0.001), respiratory quotients (p less than 0.05), and ventilatory volumes (p less than 0.05) than control subjects. Graded exercise produced a significantly higher HR than continuous or intermittent exercise (p less than 0.001) during the final data collection period. Oxygen consumption during graded exercise was higher than VO2 for continuous or intermittent exercise (p less than 0.01) during the final data collection period.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1983

Cardiopulmonary response in spinal cord injury patients: effect of pneumatic compressive devices.

The purpose of this study was to determine the effects of an inflatable abdominal corset and bilateral pneumatic leg splints on certain physiologic parameters during and after postural change in 27 quadriplegic patients. Data reflecting respiratory rate, tidal volume, heart rate, systolic and diastolic blood pressure were collected and analyzed. Measurements were acquired with patients in supine, 20 degrees head-up, 45 degrees head-up, and 20 degrees head-down positions. The study population was divided into 2 groups of cervical spinal cord injured patients: group I included 13 patients with C6 or C7 lesions; group II included 14 patients with C4 or C5 lesions. The mean time between injury and data collection was 47 days. Several trends were identified: (1) the neurologic level of lesion in quadriplegics appears relatively unimportant in determining cardiopulmonary response to postural change; (2) the use of assistive compressive devices does not improve pulmonary ventilatory parameters during postural change, although such devices do help maintain cardiovascular parameters; and (3) the abdominal corset appears more effective than pneumatic leg splints in maintaining blood pressure at pretilt levels. A tidal volume of 350ml to 400ml is most easily maintained by placing patients in a supine position and eschewing assistive compressive devices. Because the pneumatic devices proved successful in helping quadriplegic patients maintain cardiovascular stability during postural changes, therapeutic modalities, such as tilt table treatments, may be initiated at an earlier stage in the rehabilitation process.

Adolescent↗
PubMed1979

Spinal cord injury: an epidemiologic perspective.

This study examines, from an epidemiologic perspective, a series of 359 consecutive admissions to a Model Regional Spinal Cord Injury Center located in the south-eastern United States. An extensive data set which captures medical, demographic, social and psychological information, on each patient, has been statistically analysed. The appropriateness and utility of epidemiologic methodology applied to the phenomena of spinal cord injury is demonstrated and the findings resulting from the analyses are discussed.

Adolescent↗
PubMed1979

Laboratory evaluation of permissible exposure limits for men in hot environments.

Forty-six industrial workers completed a total of 653 one-hour work bouts requiring an average of 122-235 kcal/M2/hr in an environmental chamber maintained at heat stress levels ranging from 8-37 degrees C wet bulb globe temperature (WBGT). Heart rates (HR) and rectal temperatures (Tre) were measured at the end of each work bout. Environmental heat stress levels were divided into two groups - those above and those below the permissible exposure limits (PEL). The PEL is the proposed maximum environmental thermal stress to which industrial workers can be exposed without endangering their health. The number of observations in each of these regions was further divided into those which were above the recommended limits of a World Health Organization study group (HR less than or equal to 110 bpm, Tre less than or equal to 38.0 degrees C) and those which were not. The number of "safe" (HR less than or equal to 110 bpm, Tre less than or equal to 38.0 degrees C) observations in environments with heat stress less than or equal to the PEL ranged from 100% to 2.4% depending on subject acclimatization and work rate. The degree of protection was always less in the winter than in the summer and was less for higher work rates. Men who normally worked in hot environments had fewer "excessive" HR's and Tre's than those who did not.

Body Temperature Regulation↗
PubMed1979

Amputation: energy cost of ambulation.

A mobile instrument system was used to measure energy consumption by indirect calorimetry at rest and during ambulation in 25 unimpaired subjects, 6 unilateral below-knee (BK) amputee patients, 6 unilateral above-knee (AK) amputee patients and 4 bilateral AK amputee patients. To prevent the introduction of gait difficulties among the impaired subjects, each subject was permitted to walk at his own comfortable speed. Since speed thus varied among subjects, ambulation data were expressed in units of energy per foot traveled. Statistical analyses of the mean oxygen costs indicated several significant differences among the groups. In comparison to unimpaired subjects, the mean oxygen consumption was 9% higher in unilateral BK amputee patients, 49% higher in unilateral AK amputee patients and 280% higher in bilateral AK amputee patients.

Adult↗
PubMed1979

Energy cost of ambulation in paraplegic patients using Craig-Scott braces.

Energy metabolism data were collected in a series of 8 male paraplegic patients with neurologically complete spinal cord lesions between T4 and T12 (1 patient had complete motor paralysis with incomplete sensory function). Energy costs were measured at the subject's seated basal rate (mean = 17.12cal/min/kg) and during 2 separate trials at ambulation using Craig-Scott braces. The rates of ambulation reflected the patient's perceived comfortable rate and ranged from 2.2 to 44.8m/min. (mean = 14m/min). The subjects ambulated in a straight line, with the data collection instrumentation (the Mobile Automatic Metabolic Analyzer) moving alongside. Mean O2 consumption was 0.1867ml/sec/kg and mean energy cost was 52.96 cal/min/kg, which when compared to a mean of 17.12 cal/min/kg at their resting state, represents a 3-fold increase in their energy cost. Three cases were further measured for O2 debt, which ranged from 1483 to 3112 ml and was repaid completely within 10 minutes post-walk.

Adolescent↗
PubMed1978

Pulse rate-rectal temperature relationships during prolonged work.

Forty-six industrial workers performed a total of 653 1-h work bouts over a wide range of work rates )142-273 W/m2) and environmental temperatures (11-35 degrees C corrected effective temperature) in the summer and winter seasons. Simultaneous measurements of heart rates and rectal temperatures were made at the end of each work period, and the relationship between heart rate and rectal temperature was computed with standard multiple linear regression techniques. The overall regression equation is: heart rate (beats/min) = 29.3 (beats/min. degrees C) x rectal temperature (degrees C) - 988.6 (beats/min). The relationship is significantly altered by work rate and job- and season-acquired acclimatization of the subjects. These data suggest that the average heart rates of industrial workers during prolonged work can be predicted from rectal temperatures with a reasonable degree of confidence if the degree of acclimatization and work rates are known. For a rectal temperature of 38.0 degrees C the expected heart rate during prolonged work ranges from 109 beats/min in acclimatized men working at low rates to 143 for unacclimatized men working at heavy rates.

Acclimatization↗
PubMed1977

Determinants of the prescriptive zone of industrial workers.

The prescriptive zone is the range of climates in which man's body temperature is independent of climatic conditions. The environmental temperatures which define the upper limit of the prescriptive zone (ULPZ) at different work rates were determined in 46 clothed, healthy, male industrial workers; some of the men were job acclimated to heat and some were not. They performed a total of 653 work bouts of low, medium, or high intensity in environments ranging from 11 to 35 degrees C corrected effective temperature (CET) (8-37 degrees C wet bulb globe temperature). Heart rates (HR) and rectal temperatures (Tre) were measured after 1 h of work. The ULPZ was calculated from Tre data. HR's showed a similar pattern of response as Tre's except that the inflection point corresponding to the ULPZ occurred at different environmental temperatures at most of the experiment conditions. About one-third of the work bouts were performed in the summer months and the remainder in the winter. The ULPZ decreased with increasing work rates. At high, but not low, work rates, men who were exposed to heat in the performance of their jobs were more heat tolerant than men who were not heat acclimatized. Both groups were found to be more heat tolerant in the summer months than in the winter.

Acclimatization↗
PubMed1976

Insensible weight loss in patients with spinal cord transection.

Insensible weightlosses (IWL) were determined in each of 24 patients with physiologically complete spinal cord transection. The patients were placed on a bed balance with an accuracy of +/- 5 g in an environmental chamber maintained at 24 degrees C. dry bulb and 17 degrees C. wet bulb temperature. Bihourly weight changes, corrected for food and fluid ingestion, were determined for a total of 24 hours. Tetraplegics have significantly lower (P less than 0.05) IWL than paraplegics. The IWL of paraplegics are in the range of IWL of normal persons reported in the literature. We conclude that a lower allowance for IWL should be for tetraplegics than for paraplegics or persons with intact spinal cords.

Adult↗
PubMed1976

Stereospecific actions of 2,5-dimethoxy-4-methylamphetamine (DOM) on colonic temperature in the rat at various ambient temperatures.

The R(-) and S(+)-isomers of 2,5-dimethoxy-4-methylamphetamine (DOM) produce a dose-dependent hypothermia in rats kept in the cold (6 degrees C). 2 This hypothermia was linearly dependent upon ambient temperature and the R(-)-isomer was considerably more potent than the S(+)-isomer. 3 A statistically significant tachyphylaxis was observed when R(-)-DOM was administered on two successive days. The response seven days after the second injection was similar to that on the first day of injection. 4 The hypothermia induced by R(-) and S(+)-DOM was antagonized by methysergide but not by p-chlorophenylalanine (PCPA) or pimozide. Methysergide, PCPA or pimozide alone did not elicit hypothermia at the doses used. The results indicate that R(-) and S(+)-DOM act at post-synaptic 5-hydroxytryptamine receptors.

DOM 2,5-Dimethoxy-4-Methylamphetamine↗