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Biomedical subjects

L Kager

Publications and source records attributed to L Kager.

At least 73 records · Page 4Linked to original sources
PubMed1981

Utilization and metabolic effects of a conventional and a single-solution regimen in postoperative total parenteral nutrition.

A comparison was made of the effects of two intravenous regimens for postoperative total parenteral nutrition, namely, a conventional (control) regimen (group I) and a single-solution regimen of the same composition (group II). The effects examined were: hemoglobin concentration, prothrombin time, serum protein and electrolyte concentrations, and nitrogen and electrolyte balances. The 18 patients undergoing abdominal surgery were allocated at random to the two groups and the experiment was run for 3 days. During the day of the operation and the next 3 days both groups showed a decrease in the hemoglobin concentration and in the serum levels of iron, albumin, transferrin and cholesterol, while the asparagine aminotransferase increased. During total parenteral nutrition the prothrombin time and erythrocyte sedimentation rate increased in both groups. The nitrogen balance improved gradually in both groups and on the 3rd day was positive in group II. The calcium and magnesium balances indicated a higher retention and the phosphate balance a lower retention of these ions in group II than in group I. The urinary phosphate excretion rate during total parenteral nutrition decreased in both groups. This study indicates that the single-solution regimens used in intravenous nutrition caused no adverse metabolic effects and was used as efficiently as a conventional regimen in the early postoperative period.

Abdomen↗
PubMed1981

Antibiotic prophylaxis with cefoxitin in colorectal surgery: effect on the colon microflora and septic complications--a clinical model for prediction of the benefit and risks in using a new antibiotic in prophylaxis.

Cefoxitin was administered parenterally in doses of 2 g, every six hours for two days, to 20 patients undergoing colorectal surgery. Blood and fecal specimens were obtained for five days for analysis of cefoxitin concentrations. Tissue samples from the gut wall were obtained at surgery. The maximum serum concentrations during surgery varied between 25 and 100 microgram/ml, and the cefoxitin concentrations for the fecal samples were 1.5-35 microgram/g and for the tissue samples, 2.0-50 microgram/g. Fecal samples for cultivation of aerobic and anaerobic bacteria were also obtained daily during the first five days, and after 14 day after operation. Pronounced changes in the microflora occurred during the investigation period. Among the aerobic bacteria, cefoxitin-sensitive Escherichia coli and other enterobacteria decreased markedly while cefoxitin-resistant enterococci, Pseudomonas and Enterobacter proliferated during the antibiotic prophylaxis period. Among the anaerobic bacteria, Bacteroides fragilis and other Gram-negative bacteria decreased significantly. However, after the antibiotic administration period, all cefoxitin-resistant strains decreased while the suppressed E. coli and B. fragilis strains increased. In one patient, a minor postoperative infection caused by a cefoxitin-resistant strain of Pseudomonas aeruginosa was observed.

Adult↗
PubMed1981

Effect of clindamycin prophylaxis on the colonic microflora in patients undergoing colorectal surgery.

Clindamycin was given intravenously to 15 patients undergoing colorectal surgery in an initial dose of 600 mg, given at induction of anesthesia followed by 6 doses of 600 mg at 8-h intervals. Series of serum samples and fecal specimens were taken for analysis of clindamycin concentrations. Tissue samples from the gut wall were taken at surgery. The highest serum concentrations observed occurred 30 min after administration of clindamycin and varied between 6.8 and 37.9 microgram/ml (mean, 14.8 +/- 2.0 [standard error] microgram/ml). The clindamycin concentrations in the tissue samples were between 1.8 and 13.0 microgram/g. Clindamycin concentration in the fecal samples varied between 2.1 and 460 microgram/g. Fecal samples were also collected during the investigation period for cultivation of aerobic and anaerobic bacteria. Among the aerobic bacteria, enterococci and streptococci decreased during the prophylaxis period. Anaerobic bacteria also decreased significantly during the same period. After the clindamycin administration period, enterococci, streptococci and anaerobic bacteria proliferated. No anaerobic strains resistant to clindamycin were isolated. Postoperative infections due to Streptococcus faecalis and different enterobacteria such as Escherichia coli, Enterobacter cloacae, Citrobacter freundii, and Klebsiella occurred in five patients.

Adult↗
PubMed1981

Effect of tinidazole prophylaxis on the normal microflora in patients undergoing colorectal surgery.

Tinidazole was given intravenously to 20 subjects undergoing colorectal surgery in an initial dose of 800 mg, given at induction of anesthesia, and then in doses of 400 mg every 12 h for two days. Series of serum samples and faecal specimens were taken for analysis of tinidazole concentrations. Tissue samples from the gut wall were taken at surgery. The maximum serum concentrations during surgery were reached 0.5-3 h after administration of tinidazole and varied between 13 and 92 microgram/ml. The tinidazole concentrations in the tissue samples were 0.7-18.2 microgram/g. Secondary maxima of the serum concentrations were observed in 16 patients. These occurred 3 to 12 h after the antibiotic administration and ranged between 9.6 and 43.3 microgram/ml. Measureable tinidazole concentrations in the faecal samples were only found in 7 of the 18 patients during surgery and varied between 0.8 and 4.8 microgram/g. Faecal samples were also collected during the investigation period for cultivation of aerobic and anaerobic bacteria. Among the aerobic bacteria, enterococci and streptococci proliferated during the prophylaxis period. Anaerobic bacteria decreased significantly during the same period. After the tinidazole administration period, enterococci and streptococci decreased and the number of anaerobic bacteria increased. No anaerobic strains resistant to tinidazole were isolated. Postoperative infections due to Escherichia coli occurred in six cases.

Adult↗
PubMed1980

Plasma concentration of neurotensin-like immunoreactivity (NTLI) and lower esophageal sphincter (LES) pressure in man following infusion of (Gln4)-neurotensin.

(Gln4)-neurotensin was infused i.v. for 5 to 70 min at 3 different infusion rates (6, 12 and 18 pmol X kg-1 X min-1, respectively) in 19 male volunteers, aged 26-47. The plasma concentration of neurotensin-like immunoreactivity (NTLI), the lower esophageal sphincter (LES) pressure, blood pressure, heart rate. ECG and blood glucose concentration were measured. The volunteers did not report any subjective effects during the infusion. Following infusion periods of 30 min or more the volunteers often reported bowel movements starting 5 min or more after cessation of the infusion. Neither blood pressure nor heart rate changed significantly. No changes were noted in the continuous ECG or in the blood glucose concentration. Apparent steady state levels of about 300 pM NTLI were reached at about 40 min during infusion of 12 pmol X kg-1 X min-1 (Gln4)-neurotensin. In all volunteers the LES pressure was significantly reduced within 5 min of starting the infusion. In 6 volunteers 12 pmol X kg-1 X min-1 (Gln4)-neurotensin was infused i.v. for 5 min. The LES pressure decreased significantly (P less than 0.01) from 13.7 +/- 1.3 mmHg to 5.3 +/- 0.8 mmHg. The decrease in the LES pressure occurred at plasma NTLI concentrations of approximately 50 pM, i.e. at levels below those obtained in man after a meal or the ingestion of fat. The present data further support the hypothesis that in man plasma neurotensin, or a neurotensin metabolite is an endocrine hormone involved in the postprandial regulation of the motor functions of the gastrointestinal tract.

Adult↗
PubMed1979

Regional differences in the control of lipolysis in human adipose tissue.

Omental fat cells were 30% smaller than those in subcutaneous regions. In omental fat cells with a mean diameter of 95 mu, the basal cAMP concentration was 50% lower, but the basal rate of glycerol release was three times as rapid as in subcutaneous (epigastric) fat cells of identical size. Added at maximal effective concentration, noradrenaline increased the level of cAMP and the rate of glycerol release more markedly in the omental than in the subcutaneous adipocytes, whereas the response to isopropyl noradrenaline was similar. Before starvation the lipolytic effects of noradrenaline and isopropyl noradrenaline, respectively, were identical in the two regions of subcutaneous adipose tissue investigated (femoral and hypogastric). The findings were well related to the tissue levels of cAMP induced by the two agents. During starvation noradrenaline and isopropyl noradrenaline increased the cAMP level and the rate of lipolysis in fat cells obtained from the hypogastric region, whereas noradrenaline decreased these parameters in femoral adipocytes. Starvation was associated with a more prominent inhibitory effect of phenylephrine on basal and isopropyl-noradrenaline-induced lipolysis in femoral than in hypogastric adipose tissue. In conclusion, differences exist between different regions of adipose tissue in their lipolytic responsiveness to noradrenaline, which seems related to the balance between alpha- and beta-adrenergic receptor response.

Adipose Tissue↗
PubMed1979

Acute appendicitis and Bacteroides fragilis.

Bacteria belonging to the Bacteroides fragilis group (B. fragilis, B. ovatus, B. vulgatus, B. distasonis, B. thetaiotaomicron and B. uniformis) were cultured in quantities of less than or equal to 10(5) c.f.u./ml from the excised appendix from 30 patients. Twenty-two patients (group I) had an acute purulent appendicitis (three with perforation), four were classified as slightly inflamed cases (group 2) and four had a normal appendix (group 3). The B. fragilis group of bacteria dominated among the anaerobic isolates, but Bifidobacteria, Fusobacteri, Clostridium perfringens, Lactobacilli, Leptotrichia and Veillonella, in decreasing order, were isolated as well. Among isolates of aerobic bacteria, E. coli was most frequently isolated (26/30 patients). No other genus was isolated from more than four of the appendices. Serological investigations of the humoral antibody response to polysaccharide antigens from four of the Bacteroides species showed that a doubling of the titer, or more, in paired serum samples could be observed as follows: against B. fragilis 6/22 patients (group 1), 3/8 patients (groups 2 and 3). The corresponding figures for B. ovatus were 11/22 and 2/8, B. vulgatus 3/22 and 0/8 and B. distasonis 4/22 and 0/8. Sera from two patients with ruptured appendix, and B. fragilis cultivated, showed the highest titer increases against the B. fragilis antigen. The data from the bacteriological and immunological investigations make us conclude that (i) the B. fragilis group of bacteria is the most common anaerobic group of bacteria isolated from normal and diseased appendices, (ii) the mere isolation of B. fragilis, encapsulated or not, does not imply an etiological role in appendicitis since there was no obvious difference in titer increases against B. fragilis in sera from patients with or without an inflamed appendix, and (iii) high, and significant, titer increases against B. fragilis are seen in sera from patients with ruptured appendix.

Acute Disease↗