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Biomedical subjects

L Kager

Publications and source records attributed to L Kager.

At least 37 records · Page 2Linked to original sources
PubMed1986

Alterations in the human oropharyngeal microflora related to therapy with aztreonam, moxalactam and ampicillin plus sulbactam.

33 patients undergoing colorectal surgery were treated prophylactically with aztreonam (19 patients), moxalactam (10 patients) and ampicillin plus sulbactam (4 patients). The effect on the normal oropharyngeal microflora and new colonization of oropharynx were studied during and after the treatment. Aztreonam had minor effect on the normal flora but induced colonization with staphylococci. Moxalactam suppressed gram-negative aerobic and anaerobic bacteria and promoted colonization with Candida albicans. Ampicillin plus sulbactam had marked effect on the normal flora and suppressed aerobic as well as anaerobic bacteria. New colonization with enteric gram-negative rods or fungi was observed in all patients.

Adult↗
PubMed1986

Perforating appendicitis. A nine-year survey of treatment and results.

This is a clinical study of 193 adult cases of perforating appendicitis during a nine-year period of treatment. There were 77 females (39.9%) and 116 males (60.1%) with ages of 15 years and above. Throughout the study period, the yearly perforation frequency ranged from 10.0 to 23.1% (mean 16.7%) of all cases with proven appendicitis. Perforation was equally common in both sexes, females: 15.5%, males: 17.6% of the appendicitis cases. In elderly patients (greater than or equal to 60 years of age) perforation was much more common; 37 out of 77 cases with proven appendicitis (48.1%). Compared to different ages (patients under and above 60 years of age), clinical and laboratory findings were found equal. Duration of symptoms showed no differences for younger and elderly patients. Preoperative delay in the hospital of at least 6 hours occurred in 39.9% of all patients, and was found equally common in patients younger than 60 years (39.1%) and in those from 60 years and older (43.2%). There were no fatalities in the study group. Postoperative septical complications predominated over non-septical (32.6 versus 9.3%), and were equally common in both sexes and in patients of different ages. The frequency of occurrence of septical complications was not significantly influenced by the duration of symptoms or by the duration of operation, furthermore, septical complications were equally frequent throughout the study period, although the use of antibiotics changed towards drugs more potent to cover anaerobic bacteria (28.1% infections for the period 1972-1976 versus 29.8% for the period 1977-1981).(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1986

Antimicrobial induced alterations of the human oropharyngeal and intestinal microflora.

Although the role of the normal oropharyngeal and intestinal microflora is not fully understood, there are evidences that alterations in the flora may have serious consequences. The most common and significant cause of disturbances in the normal microflora is the administration of antimicrobial agents. The microflora can be influenced by antimicrobial agents because of incomplete absorption of any orally administered antimicrobial agent, secretion of an antimicrobial agent by the salivary glands or in the bile, or secretion from the intestinal mucosa. In most cases the influence is not beneficial to the patient because suppression of the indigenous microorganisms often permits potential pathogens to overgrow and cause septic conditions, stomatitis, diarrhoea, or colitis. Antimicrobial agents that influence the normal microflora also promote the emergence of antimicrobial-resistant strains. During the recent years, the impact of different antimicrobial agents on the human microflora has been investigated by our research group. Thus the effects on the oropharyngeal and intestinal microflora by peroral administration of penicillin, bacampicillin, erythromycin, clindamycin, doxycycline, nitroimidazole, norfloxacin and ciprofloxacin have been studied. The impact on the microflora by parenteral administration of ampicillin + sulbactam, azlocillin, aztreonam, piperacillin, cefoperazone, cefoxitin, ceftriaxone, moxalactam, imipenem, nitroimidazole and clindamycin has also been investigated. Pronounced changes were observed in the microflora in patients receiving clindamycin, erythromycin, cefoperazone, ceftriaxone and moxalactam, whereas moderate changes were seen in those patients receiving doxycycline, cefoxitin, aztreonam, ampicillin + sulbactam, azlocillin and piperacillin. Penicillin, bacampicillin, imipenem, nitroimidazole, ciprofloxacin and norfloxacin produced only minor changes.(ABSTRACT TRUNCATED AT 250 WORDS)

Anti-Bacterial Agents↗
PubMed1986

Impact of cefbuperazone on the colonic microflora in patients undergoing colorectal surgery.

Cefbuperazone was given intravenously in a dose of 1 g at induction of anaesthesia, followed by a subsequent dose of 1 g 12 h after the first dose, to 10 patients undergoing colorectal surgery. A series of serum and faecal specimens were taken for analysis of cefbuperazone concentrations. Tissue samples from the gut wall were taken at surgery. The maximum serum concentrations (mean value 98.6 +/- 9.1 mg/l) during surgery were reached 30 min after cefbuperazone administration. The cefbuperazone concentration in the tissue samples varied between 7.3 and 40.5 mg/kg and the concentration in the faecal samples between 0 and 27.0 mg/kg. Faecal samples were also collected during the investigation period for cultivation of aerobic and anaerobic bacteria. The aerobic bacteria--streptococci, enterococci and enterobacteria--were suppressed significantly during the prophylaxis period. Among the anaerobic bacteria, cocci, bifidobacteria, eubacteria, lactobacilli, clostridia, fusobacteria and bacteroides decreased markedly during the same period. After four weeks the microflora was normalized in all patients. No postoperative infections occurred.

Adult↗
PubMed1985

Oral morphine in cancer patients: in vivo kinetics and in vitro hepatic glucuronidation.

The kinetics of morphine and formation of the main metabolite, morphine-3-glucuronide (M3G) after single and intravenous doses of morphine were studied in six cancer patients and compared with the formation rate of M3G in vitro in microsomes isolated from liver biopsies obtained from the same patients at palliative laparotomy. The results showed that high formation rates of M3G in vitro in microsomes isolated from liver biopsies were associated both with high apparent oral clearance values and high M3G/morphine AUC (area under the concentration vs time curve) ratios as measured in vivo in the same patients. In accordance with previous results marked interindividual differences were seen in the kinetics of morphine; the oral bioavailability varied between 30 and 69% and the systemic plasma clearance between 18.6 and 34.0 ml min-1 kg-1. This variation correlated with the variation in morphine metabolism as assessed in vitro. In vivo, a high M3G/morphine AUC ratio predicted a high oral clearance. Hepatic UDP-glucuronyl transferase activity is thus an important determinant of the in vivo kinetics of orally administered morphine.

Administration, Oral↗
PubMed1985

Changes in the oropharyngeal and colon microflora in relation to antimicrobial concentrations in saliva and faeces.

Phenoxymethylpenicillin, bacampicillin, clindamycin, erythromycin, doxycycline and tinidazole were given perorally for 7 days to a total of 56 subjects. Concentrations of antimicrobials in serum, saliva and faeces were determined daily, as were viable counts of different aerobic and anaerobic microorganisms in the oropharyngeal and colon microflora. Clindamycin, erythromycin, doxycycline and tinidazole were detected in saliva. Clindamycin, erythromycin and doxycycline were also detected in high concentrations in faeces. Phenoxymethylpenicillin, bacampicillin, tinidazole and doxycycline did only induce small changes in the oropharyngeal and colon microflora, while distinct suppression of anaerobic bacteria was observed in the oropharynx and colon when clindamycin was administered. Erythromycin decreased the numbers of aerobic bacteria in oropharynx and both aerobic and anaerobic bacteria in colon. Both clindamycin and erythromycin induced new colonization of the oropharynx and colon by potentially pathogenic Gram-negative enteric rods and fungi as well as toxin-producing clostridia.

Adult↗
PubMed1984

Impact of antimicrobial agents on the gastrointestinal microflora and the risk of infections.

The most common and significant cause of disturbances in the normal gastrointestinal microflora is the administration of antimicrobial agents. The microflora can be influenced by antimicrobial agents because of incomplete absorption of any orally administered antimicrobial agent, secretion of an antimicrobial agent by the salivary glands and in the bile, or secretion from the intestinal mucosa. In most cases the influence is not beneficial to the patient because suppression of the indigenous microorganisms often permits potential pathogens to overgrow and cause septic conditions, diarrhea, or colitis. Antimicrobial agents that influence the normal microflora also promote the emergence of antimicrobial-resistant strains. The authors' experience on the impact of different beta-lactams, erythromycin, clindamycin, tetracycline, and nitroimidazoles on the gastrointestinal microflora and the risk of infections when these agents are used is reviewed.

Anti-Bacterial Agents↗
PubMed1984

Binding and molecular weight properties of the insulin receptor from omental and subcutaneous adipocytes in human obesity.

The insulin binding properties and the molecular weights of the insulin receptor and its insulin binding subunit were studied in omental and subcutaneous adipocytes prepared from obese- and normal-weight subjects. Insulin binding by such adipocytes was decreased in obesity when the binding activity was expressed per unit of cell surface area. No significant difference from the lean controls was evident, however, when binding was calculated on a per cell basis, indicating that the total receptor content of the cells from the obese subjects was not altered. In addition, the normal difference in the receptor binding affinities previously reported between omental and subcutaneous cells from lean individuals was unaffected by the obese condition. Studies of the molecular weight of the non-reduced insulin receptor in fat cell membranes prepared from pieces of omental and subcutaneous fat demonstrated a major receptor species of 390-425K Mr. In contrast, adipocytes isolated by collagenase treatment of the fat had heterogeneous non-reduced receptor species of Mr 355K, 285K and small amounts of 427K and 182K. Although different non-reduced receptor species were evident depending on the adipocyte receptor preparation (e.g. isolated adipocytes or fat cell membranes), no differences were found between obese and lean controls or between subcutaneous and omental receptors when the appropriate comparisons were made. Upon sulphydryl reduction, all receptor preparations had a major binding subunit of 125K Mr. In conclusion, obesity is characterized by a dilution of the insulin receptor over the adipocyte cell surface in the absence of a change in total cellular content of receptors.(ABSTRACT TRUNCATED AT 250 WORDS)

Adipose Tissue↗
PubMed1984

Impact of imipenem/cilastatin therapy on faecal flora.

To evaluate the effects of parenteral imipenem/cilastatin therapy upon human faecal microflora, stool specimens obtained from ten patients before, during and after therapy were cultured quantitatively for aerobic and anaerobic microorganisms. The patients received 500 mg imipenem combined with 500 mg cilastatin every 6 h for 6-11 days. The antimicrobial therapy was associated with a small decrease in the numbers of enterobacteria, anaerobic cocci and bacteroides during treatment but afterward the microflora normalized in all patients. None of the patients was colonized with new imipenem-resistant bacteria, had Clostridium difficile or cytotoxin in the stools, or developed diarrhoea.

Adult↗
PubMed1984

Long-term effects of papillotomy.

Forty-three patients who were papillotomied according to Doubilet were followed up for 20-25 years after the papillotomy in an attempt to predict the long-term effects of endoscopic papillotomy (EPT). The indications for the initial papillotomy was common bile duct stones in 20 patients, and elevated serum amylase in 23. The papillotomy was performed in conjunction with a cholecystectomy. No negative effects were found at follow-up, and this study therefore seems to show that the long-term risks of EPT are minimal.

Aged↗
PubMed1984

Impact of single dose as compared to three dose prophylaxis with latamoxef (moxalactam) on the colonic microflora in patients undergoing colorectal surgery.

Twenty patients undergoing colorectal surgery were given an initial dose of 2 g latamoxef (moxalactam) parenterally at the induction of anaesthesia. Ten of the patients received two subsequent doses at 8 h intervals. A series of serum and faecal specimens were taken for analysis of latamoxef concentrations. Tissue samples from intestinal mucosa and peritoneal fat were also taken at surgery. The mean serum peak level was 119.8 +/- 10.7 mg/l. The mean half life was 2.8 h and the mean area under the serum concentration curve was 345.0 +/- 25.7 mg h/l. The concentrations in intestinal mucosa were high when the tissue was removed within 4 h after the administration of latamoxef (22.6 +/- 1.7 micrograms/g, mean +/- S.E.). The concentrations declined when the tissues were removed later (7.8 +/- 0.7 micrograms/g). The content of latamoxef in peritoneal fat varied, range 0.8-23.4, mean 8.5 +/- 1.4 micrograms/g. Measureable levels of latamoxef in faeces were found in all patients except one. The values varied between 0.2 to 23.0, mean 8.9 +/- 1.5 micrograms/g. Faecal samples were also collected during the investigation period for cultivation of aerobic and anaerobic bacteria. The aerobic bacteria-streptococci, enterococci and enterobacteria--were suppressed significantly during the prophylaxis period. Among the anaerobic bacteria--cocci, lactobacilli, bifidobacteria, clostridia, bacteroides and fusobacteria--decreased markedly during the same period. After two weeks the microflora was normalized in all patients. There were no differences between the patients receiving one dose of latamoxef and those receiving three doses. No postoperative infections occurred.

Adult↗
PubMed1984

Use of new beta-lactam antibiotics in intraabdominal surgery.

Infections after gastrointestinal surgery may involve both Gram-positive and Gram-negative aerobic and anaerobic microorganisms. Although the broadspectrum cephalosporins are active against most Gram-positive and Gram-negative bacteria, many of these agents are ineffective against Bacteroides fragilis, many clostridia and some strains of Escherichia coli, Pseudomonas aeruginosa and enterococci. These bacteria are frequently found in intraabdominal infections. A major reason for this inefficacy is susceptibility to beta-lactamases. The new beta-lactam antibiotics--cephamycins, third generation cephalosporins, carbapenems, acyl ureidopenicillins and monobactams--are all more or less beta-lactamase stable. The beta-lactamase inhibitors combined with a beta-lactam antibiotic give a broad antibacterial spectrum. Most of these compounds are non-toxic or relatively atoxic and, with the exception of the monobactams, they can be used as a monotherapy in many infections derived from the gastrointestinal tract. Antibiotic prophylaxis in colorectal surgery offers a clinical model for the study of the benefit and risks of new beta-lactam antibiotics. Most infections are derived from the gastrointestinal endogenous microflora. The study of the impact of different antibiotics on the colonic microflora indicates the risk of bacterial resistance, superinfection, antibiotic associated diarrhoea and pseudomembranous colitis. Data obtained from such studies with the new beta-lactam antibiotics are compared to the results from controlled clinical trials with these antibiotics in this review article.

Anti-Bacterial Agents↗