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Biomedical subjects

W Graninger

Publications and source records attributed to W Graninger.

At least 19 recordsLinked to original sources
PubMed1992

Extracorporeal photochemotherapy for the treatment of systemic lupus erythematosus. A pilot study.

OBJECTIVE: To investigate the effectiveness and feasibility of extracorporeal photochemotherapy (ECP) in the treatment of an autoimmune disease with known cutaneous photosensitivity. METHODS: Ten patients with systemic lupus erythematosus (SLE) were treated with ECP in an open clinical trial. The efficacy of treatment was analyzed by means of established disease activity scores. RESULTS: Eight patients completed the trial. In 7 of the 8, there was a significant response to the treatment, with no or minor side effects. The clinical activity score in the group of 8 patients decreased from a median of 7 (range 4-9) to a median of 1 (range 0-5) (P less than 0.05). Laboratory abnormalities did not change significantly, but were mild at the outset. CONCLUSION: ECP led to clinical improvement of SLE without side effects. The effectiveness of this method should be investigated further in controlled clinical trials.

Adult↗
PubMed1992

Cardiac involvement in systemic sclerosis.

OBJECTIVE: To assess the incidence and extent of cardiac involvement in systemic sclerosis (SSc) patients with no apparent cardiac symptoms. METHODS: Surface electrocardiography, ambulatory electrocardiography, radionuclide ventriculography, myocardial scintigraphy, and echocardiography were performed in 18 patients. RESULTS: These studies demonstrated ventricular tachycardia in 1 patient, nonsustained ventricular tachycardia in 5, supraventricular tachycardia in 6, decreased left ventricular ejection fraction in 2, decreased right ventricular ejection fraction in 8, and stress-induced reversible myocardial perfusion abnormalities in 6. CONCLUSION: These observations demonstrate a high rate of cardiac abnormalities in SSc patients without cardiac symptoms.

Aged↗
PubMed1992

High incidence of asymptomatic urogenital infection in patients with uveitis anterior.

Acute anterior uveitis (AAU) may be associated with systemic infectious or inflammatory disease. We examined 92 patients with the first attack of acute anterior uveitis; all patients were free of any extraocular symptoms. A thorough clinical examination did not reveal any systemic underlying disease. In the course of microbiological examination, however, a high incidence of asymptomatic infection of the urethra and/or cervix with ureaplasma urealyticum, chlamydia trachomatis and mycoplasma hominis was found. Infections with ureaplasma were significantly more frequent in patients with AAU when compared with a sex- and age-matched control group. There was no statistically valid association of these infections with the HLA-B27 phenotype in the patients. The higher rate of urogenital infections in patients with AAU may reflect a higher rate of sexual promiscuity. Transmission of infectious agents seems to be one possible factor in the pathogenesis of AAU.

Acute Disease↗
PubMed1992

Serum protein concentrations in Plasmodium falciparum malaria.

In patients with uncomplicated Plasmodium falciparum infection cytokine-mediated serum protein levels of C-reactive protein (CRP), coeruloplasmin (COE), beta 2-microglobulin (B2M), alpha 1-acid glycoprotein (AAG), alpha 1-antitrypsin (AAT), haptoglobin (HPT), prealbumin (PRE), retinol binding protein (RBP), albumin (ALB) and transferrin (TRF) were measured in an endemic area of the Amazonian rain forest. Semi-immune (SI) and nonimmune (NI) patients were investigated. In both patient groups the serum concentrations of CRP, COE and B2M were elevated on admission. In addition AAG and AAT concentrations were increased in NI patients compared to control subjects. Significantly lower serum concentrations of HPT, PRE, RBP, ALB and TRF were seen in both patient groups during the acute phase of the disease, and were more pronounced in NI patients. After a 28-day follow-up, AAT and B2M were normal in SI patients but HPT, AAT and B2M were still significantly altered in NI patients.

Acute-Phase Proteins↗
PubMed1992

Short-term energy balance in patients with infections: carbohydrate-based versus fat-based diets.

The effects of a carbohydrate-based diet (50% carbohydrate calories, 30% fat calories, 20% protein calories) versus a fat-based diet (28% carbohydrate calories, 55% fat calories, 17% protein calories) on oxidation rates of carbohydrate, fat, and protein were assessed in 12 patients with infections by indirect calorimetry and estimation of urea nitrogen production rate. The diets were given continuously for 18 hours in a randomized cross-over study on 2 consecutive days. Energy supply (kcal/d) was adjusted individually to meet the energy expenditure measured on the preceding day after an overnight fast and was 1,647 +/- 129 (SEM) for the carbohydrate-based diet and 1,655 +/- 131 for the fat-based diet. Oxidation rates (kcal/d) for carbohydrate (carbohydrate-based diet, 525 +/- 70; fat-based diet, 363 +/- 84) were different between the diets (P less than .05), whereas no difference could be found for fat (carbohydrate-based diet, 820 +/- 117; fat-based diet, 968 +/- 136) and protein (carbohydrate-based diet, 252 +/- 29; fat-based diet, 236 +/- 23). However, during carbohydrate-based feeding, carbohydrate balance (288 +/- 93 kcal/d) and fat balance (-327 +/- 107 kcal/d) were significantly different from zero (P less than .05), indicating continuous oxidation of endogenous fat and storage of administered glucose. During the fat-based diet, carbohydrate and fat balances were not different from zero. A correlation between energy and substrate balances was not seen during either diet.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1992

Nosocomial bacteremia due to Enterococcus faecalis without endocarditis.

During a 2-year observation period at a 2,200-bed university hospital, bacteremia due to Enterococcus faecalis was observed in 111 patients. Fifty-five patients with nosocomial bacteremia due to E. faecalis could be evaluated. The most common entry sites were the urinary tract (25%), the intraabdominal cavity (13%), and burn and decubital wounds (11%). Bacteremia was preceded by administration of cephalosporins, imipenem, and aztreonam (n = 39); ciprofloxacin (n = 11); and other antibiotics (n = 4). Age, sex, underlying disease, portal of entry, previous antibiotic therapy, and bacteremia due to other organisms had no influence on mortality. Treatment of bacteremia with penicillins (n = 45) and glycopeptides (n = 4) resulted in a mortality rate of 37%. The addition of a high-dose aminoglycoside to a penicillin did not result in a better survival rate.

Adult↗
PubMed1992

Serum concentrations of immune parameters during acute cardiogenic pulmonary edema.

OBJECTIVE: To evaluate the effect of acute cardiogenic pulmonary edema on the concentrations of immune parameters in serum. DESIGN: Prospective, controlled study. SETTING: Medical ICU. PATIENTS: Twenty-four consecutive patients with acute pulmonary edema who had significant clinical improvement within 30 mins and did not show any evidence of either tissue damage or infection. For comparison, 25 healthy, age-matched controls and 25 patients with mild chronic heart failure were also studied. INTERVENTIONS: Treatment with oxygen, nitrates, and loop diuretics. MEASUREMENTS: Lymphokines, acute-phase reactants, and cortisol concentrations were measured in serial serum and plasma samples. MAIN RESULTS: Serum concentrations of soluble CD-8 antigen (soluble CD-8) decreased from 928 +/- 124 (SEM) U/mL on admission to 712 +/- 112 and 579 +/- 67 U/mL after 2 and 6 hrs, respectively (p less than .05, p less than .01), and returned to baseline values within 48 hrs (853 +/- 109 U/mL). Concentrations of soluble interleukin-2 receptor increased from 721 +/- 71 to 1078 +/- 112 and 1226 +/- 128 U/mL 12 and 36 hrs, respectively, after admission (p less than .05, p less than .01). Plasma cortisol concentrations were markedly increased on admission (56.9 +/- 4.7 vs. 13.1 +/- 1.3 micrograms/dL after recovery, p less than .001). Increased cortisol concentrations coincided with the nadir of soluble CD-8. Tumor necrosis factor-alpha remained within normal limits in all patients. Neither acute-phase reactants nor angiotensin converting enzyme activity showed significant changes during the observation period. CONCLUSION: The present results indicate significant alterations in the serum concentrations of immune parameters as an effect of an uncomplicated acute cardiogenic pulmonary edema.

Acute Disease↗
PubMed1992

Antibacterial activity of sparfloxacin against experimental renal infections in mice.

In a murine model of renal infection (Staphylococcus aureus and Escherichia coli), sparfloxacin was compared with ciprofloxacin and fleroxacin. After intrarenal inoculation, mice were treated orally for 5 days. The drugs were administered at five different dosages, ranging from 3.125 to 50 mg/kg of body weight per day for S. aureus and from 0.78 to 12.5 mg/kg/day for E. coli. Evaluation of efficacy was based on the proportional reduction of bacterial counts in the kidney tissues of treated animals compared with those of untreated control animals. For S. aureus, the doses required to clear the infection in 50% of mice were as follows: sparfloxacin, 10 mg/kg/day; ciprofloxacin, 33 mg/kg/day; and fleroxacin, 16 mg/kg/day. For E. coli renal infection, the corresponding dosages were as follows: sparfloxacin, 1.5 mg/kg/day; ciprofloxacin, 2.45 mg/kg/day; and fleroxacin, 1.8 mg/kg/day. Sparfloxacin and fleroxacin have a lower effective dose than ciprofloxacin in these models, probably because ciprofloxacin has a shorter serum half-life than the other two compounds.

Abscess↗
PubMed1992

Bed-side infection screening of ICU patients using gram stained smears.

Bronchial, abdominal or pleural aspirates (n = 364) collected from 165 ICU patients were both cultivated and evaluated microscopically using Gram stained smears, and the results were compared: 331 aspirates (91%) were classified correctly. Fungi were confirmed in all cases (21/21, sensitivity and specificity 100%). Gram-negative findings (n = 66) had a specificity of 97% (2/66 reclassified as Gram positive by culture): 21/85 Gram-negative cultures were overlooked by the Gram method (sensitivity 75%). Of 106 Gram-positive results, culture was negative in 10/106 and 7/106 were diagnosed as Gram-negative (specificity 84%). Sensitivity was 98% (only 2/91 not detected by the Gram technique). In 171 cases, no organisms were seen; specificity was 92% (Gram-negative bacteria cultivated in 14/171). Sensitivity was 94% (10/167 misdiagnosed as Gram-positive). Gram diagnoses were available 63 +/- 14 h prior to the culture test results. Treatment decisions based upon the Gram results were correct in 90% (326/364). It is concluded that Gram stained smears are a valuable tool for bed-side infection screening in ICU patients.

Adolescent↗
PubMed1991

Sonographic demonstration of septicaemia with gas-forming organisms after liver transplantation.

Sepsis with gas-forming organisms, e.g. Clostridium perfringens and anaerobic streptococci occurred in three of 120 liver-transplant recipients (2.5%). The diagnosis was made in all three patients by bedside ultrasound, before blood cultures revealed bacterial growth. Floating high amplitude echoes within the extra- and intrahepatic portal veins and persistent small high amplitude echoes in the non-dependent portion of the liver are indicative of portal venous gas and should prompt further laboratory investigations.

Adult↗
PubMed1991

[Therapy of urinary tract infection].

The choice of therapy in urinary tract infections depends on the infection site, complications, previous history, and recrudescence. Acute uncomplicated urinary tract infections which do not respond to general measures as increased fluid intake will be cured with antibiotics for 3 days. If the compliance of the patient is sufficient a single shot therapy may be applied. Infections of the upper urinary tract with typical signs such as fever, nausea and increase of the so-called acute phase proteins have to be treated with antibiotics for 7 to 14 days. When treating the first episode of urinary tract infection the choice of antibiotics is unimportant. Trimethoprim and quinolones are standard. In recurrent infections urine cultures and susceptibility testing are mandatory. Patients with recurrent urinary tract infections should receive a long-term suppressive therapy with low-dose trimethoprim or a quinolone. Patients with urinary catheters must not receive any long-term therapy.

Anti-Bacterial Agents↗
PubMed1991

[Infectious complications due to central venous polymeric catheters].

Due to the multitude of invasive procedures of today's intensive care medicine, infections from central venous catheters have gained increasing attention. The incidence of bacteremias arising from such devices ranges from less than 0.1 to 0.6 cases per 100 catheter-days. Factors influencing the incidence of catheter-associated infections are related to patient characteristics as well as the purpose and material of the catheter. Silicone catheters seem to carry a lower risk of infection than common polytetrafluorethylene catheters. The most frequently isolated bacteria in catheter-associated infections are coagulase-negative and coagulase-positive staphylococci, enterococci, and pseudomonas species. Septicemias due to Candida albicans frequently complicate the course of immune-compromised patients receiving total parenteral nutrition (TPE). Catheter-associated bacteremias (CAB) can arise from the contaminated hub, from which pathogens migrate intraluminally to the blood stream. When the catheter entry site is infected, bacteria may reach the blood via the extraluminal route and cause septicemia. Endemic outbreaks of CAB often originate from contaminated infusion fluids. As the clinical presentation of "catheter infections" is often uncharacteristic and insidious, a definite diagnosis depends on bacteriological examination of the catheter. Quantitative and semiquantitative culture techniques of the catheter tip help to distinguish colonization from contamination by numbers of colony-forming units per milliliter culture medium. Preliminary results can be obtained by simple Gram or acridine-orange staining of the catheter tip. The most important prophylactic measures to prevent CAB are strictly aseptic conditions when catheters are placed and meticulous care thereafter, preferably by specially trained nurses or "TPE teams".(ABSTRACT TRUNCATED AT 250 WORDS)

Bacterial Infections↗
PubMed1991

[Ineffectiveness of diltiazem in Duchenne muscular dystrophy: a placebo-controlled double-blind study].

In a randomized double-blind study the clinical efficacy of the calcium channel blocker, diltiazem was compared to that of a placebo on the clinical course of Duchenne's dystrophy (DMD) over a 12-month period. Altogether 30 patients, mostly in an advanced state of the disease, were evaluated. The 17 patients in the diltiazem group received 90-360 mg diltiazem per day according to their body weight; the 13 patients of the placebo group received the equivalent amount of a placebo. No significant difference was detected between the two groups regarding muscular power, muscle state, muscular functional ability (Vignos), serum myoglobin and serum creative phosphokinase.

Adolescent↗
PubMed1991

[Successful bridge transplantation with the Vienna artificial heart].

The Vienna Heart, a pulsatile artificial ventricle, vacuum-formed from Pellethane has been used successfully as total artificial heart (TAH) and left ventricular assist device (LVAD) to bridge over patients in terminal heart failure. A 50 year-old patient with cardiomyopathy had to be resuscitated and was transferred in cardiogenic shock, with impaired renal and liver function. 6 days after orthotopic implantation of a Vienna TAH a suitable donor organ was found and the patient was transplanted. 7 weeks later he was discharged and is alive and well now. A 40-year-old patient was transferred in cardiogenic shock 22 days after recurrent anterior infarction. Due to renal failure he was on haemofiltration. Congestive liver failure caused a severe coagulation disorder so a Vienna LVAD was implanted without the use of extracorporeal circulation. Despite development of septicaemia he was transplanted 24 days later. It was thought that either the ventricular thrombus or the LVAD was the septic focus. All consecutive blood cultures have been negative and he was discharged 6 weeks later. To our knowledge, case 1 represents the first successful bridging with a non-Jarvic TAH. The second case shows that sepsis is not necessarily a contraindication to heart transplantation.

Adult↗