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Breakdown of blood pressure and body fluid homeostasis in heart transplant recipients.

OBJECTIVES: This study was designed to investigate disturbances in arterial blood pressure and body fluid homeostasis in stable heart transplant recipients. BACKGROUND: Hypertension and fluid retention frequently complicate heart transplantation. METHODS: Blood pressure, renal and endocrine responses to acute volume expansion were compared in 10 heart transplant recipients (57 +/- 9 years old [mean +/- SD]) 20 +/- 5 months after transplantation, 6 liver transplant recipients receiving similar doses of cyclosporine (cyclosporine control group) and 7 normal volunteers (normal control subjects). After 3 days of a constant diet containing 87 mEq/24 h of sodium, 0.154 mol/liter saline was infused at 8 ml/kg per h for 4 h. Blood pressure and plasma vasopressin, angiotensin II, aldosterone, atrial natiuretic peptide and renin activity levels were determined before and at 30, 60, 120 and 240 min during the infusion. Urine was collected at 2 and 4 h. Blood pressure, fluid balance hormones and renal function were monitored for 48 h after the infusion. RESULTS: Blood pressure did not change in the two control groups but increased in the heart transplant recipients (+15 +/- 8/8 +/- 5 mm Hg) and remained elevated for 48 h (p < or = 0.05). Urine flow and urinary sodium excretion increased abruptly in the control groups sufficient to account for elimination of 86 +/- 9% of the sodium load by 48 h; the increases were blunted (p < or = 0.05) and delayed in the heart transplant recipients, resulting in elimination of only 51 +/- 13% of the sodium load. Saline infusion suppressed vasopressin, renin activity, angiotensin II and aldosterone in the two control groups (p < or = 0.05) but not in the heart transplant recipients. Heart transplant recipients had elevated atrial natriuretic peptide levels at baseline (p < or = 0.05), but relative increases during the infusion were similar to those in both control groups. CONCLUSIONS: Blood pressure in heart transplant recipients is salt sensitive. These patients have a blunted diuretic and natriuretic response to volume expansion that may be mediated by a failure to reflexly suppress fluid regulatory hormones. These defects in blood pressure and fluid homeostasis were not seen in liver transplant recipients receiving cyclosporine and therefore cannot be attributed to cyclosporine alone. Abnormal cardiorenal neuroendocrine reflexes, secondary to cardiac denervation, may contribute to salt-sensitive hypertension and fluid retention in heart transplant recipients.

Angiotensin II↗

Impact of shelter in hot Mediterranean climate on feed intake, feed utilization and body fluid distribution in sheep.

Sheep fully exposed to Mediterranean summer conditions had a higher respiration rate and a higher body temperature than sheep with access to shade. Nevertheless, feed intake and water intake of non-sheltered animals was not different from that of sheltered ones and both maintained their body weight on medium quality hay. Apparent digestibility of organic matter was higher in the non-sheltered animals than in the sheltered ones. The mean retention time of undigested feed in the rumen and in the entire digestive tract was higher in the non-sheltered animals than in the sheltered ones. Water turnover rate was only slightly higher in the non-sheltered animals than in the sheltered ones. However, plasma volume and extracellular volume were significantly higher in non-sheltered than in sheltered animals. The volume of water in the alimentary tract was not different between the two groups.

Animal Nutritional Physiological Phenomena↗

Increased nickel concentrations in body fluids of patients with chronic alcoholism during disulfiram therapy.

Nickel concentrations were measured by electrothermal atomic absorption spectrophotometry in body fluids of 61 patients with chronic alcoholism during disulfiram treatment (tetraethylthiuram disulfide, 250 mg/day, po). Nickel concentrations in serum, whole blood, and urine were significantly increased at 12 hours after the initial dose of disulfiram. In serum and whole blood, the Ni concentrations reached a plateau after two weeks of treatment; in urine, the Ni concentrations increased progressively during the initial four months of treatment. During the interval from four months to three years of disulfiram treatment, the median concentrations of nickel in serum, whole blood, and urine were elevated 17-, 15-, and 39-fold, respectively, compared to pretreatment values. The effects of disulfiram on nickel metabolism evidently involve chelation of dietary nickel by diethyldithiocarbamate (DDC), a disulfiram metabolite, and gastrointestinal absorption of the Ni-DDC complex. Since animal studies have demonstrated cerebral uptake of the lipophilic Ni-DDC complex, nickel may possibly accumulate in brain cells of disulfiram-treated patients; physicians should therefore be cautious in administering disulfiram to persons with nickel-containing orthopedic prostheses or occupational exposures to nickel.

Adult↗

Apatite growth on calcium adsorbed surface of wet flocculated silica particles immersed in a modified simulated body fluid.

An alternative method for the calcium phosphate apatite formation onto the surface of flocculated pure silica particles is reported, in an attempt to understand the possible mechanism for the apatite formation. A stable silica sol was flocculated by adding calcium ions in aqueous solution. The wet flocks were resuspended in a basic aqueous solution containing a calcium salt, trying to allow the absorption of calcium ions onto the silica surface through a hydrogen ion exchange. The as-prepared materials were immersed in a modified simulated body fluid at different temperatures (37 and 90 degrees C) and silica concentrations. It was found that these factors have a strong influence on the apatite formation. The apatite formation was confirmed by (31)P MAS-NMR, FT-Raman, XRD, and TEM.

Adsorption↗

Comparison of the distribution of tobramycin and gentamicin in body fluids of dogs.

Tobramycin serum, thoracic lymph, renal lymph, and urine concentrations were measured in mongrel dogs after intravenously administered 5, 10, and 20 mg/kg doses. These were compared with intravenous gentamicin delivered at 5 and 20 mg/kg. Both drugs achieved similar concentrations in serum and thoracic lymph. At 20 mg/kg, tobramycin showed consistently higher renal lymph and urine concentrations than gentamicin. At 5 mg of tobramycin per kg, renal lymph and urine concentrations were higher than with gentamicin only within the 1st h after administration. Thereafter the difference was no longer significant. These data suggest that on the basis of distribution in the body fluids of dogs, tobramycin is a reasonable alternative to gentamicin.

Animals↗

Neutral steroid metabolites in patients with uraemia and after renal transplantation: a quantitative and qualitative study in body fluids.

Steroid metabolites enriched from urine, haemofiltrate, and CAPD-dialysate (Continuous Ambulatory Peritoneal Dialysis) were identified by gas chromatography-mass spectrometry and quantified by capillary gas chromatography. The study included twenty healthy controls, twenty-six non-dialysed uraemics, thirty-nine patients on regular dialysis treatment, and twenty-two allograft recipients. Compared to the 24 h urinary excretion rates of controls the excretion rates of androsterone and etiocholanolone were in the lower normal range up to significantly decreased in the body fluids of all patients, and those of the corticoid metabolites were also significantly decreased. 11-Oxygenated androstanolones in urine from non-dialysed uraemics correlated significantly decreased. 11-oxygenated androstano-levels and were significantly increased, but normal in haemofiltrate and CAPD-dialysate, while in urine of allograft recipients the values were significantly lower.

Adrenal Cortex Hormones↗

Addressing blood and body fluid spills: conserving time and resources during surface disinfecting.

As new issues and areas of concern arise in the health care industry, such as the potential transmission of HIV and HBV, adaptive measures will continue to be developed to assist health care professionals in their mission to provide expert medical care for patients and safe environments in which to practice. Health care institutions must commit to exploration of the advances in infection control that employ improved measures to manage the cleaning and disinfecting of spill incidents involving blood and/or body fluids and the disinfecting of contaminated surfaces. Together, product manufacturers and health care workers will discover new ways to save time, money, and resources. The goal for health care administrators should be to focus on products that stress simplicity, efficiency, cost containment, and, most important, the safety of staff and patients.

Blood↗

In vitro antifungal susceptibility testing and measurement of levels of antifungal agents in body fluids.

Interpretation of in vitro susceptibility data for antifungal drugs is hindered by the absence of standardized test criteria. Thus, it is extremely difficult to identify a clear relation between minimal inhibitory concentrations and clinical outcome. The situation appears more readily resolvable for yeast-like than for filamentous fungi since the former are more easily quantified by standardized microbiologic techniques. Accordingly the National Committee for Clinical Laboratory Standards has initiated the process of developing standards for yeast susceptibility testing. A related issue concerns the measurement of antifungal agents in body fluids. Whereas there may be little value in measuring concentrations of amphotericin B (because of its predictable pharmacokinetics), there is value to measuring levels of flucytosine (serum concentrations may relate to bone marrow suppression and/or the development of drug resistance) and ketoconazole (which may be absorbed unpredictably from the gut). Laboratory standards for these measurements have not been established.

Amphotericin B↗

Monoclonal antibody 44-3A6 as an adjunct in cytodiagnosis of adenocarcinomas in body fluids.

Monoclonal antibody (MCA) 44-3A6 detects a cell-surface transmembrane phosphoprotein frequently expressed by pulmonary adenocarcinoma (AC) and associated with glandular differentiation. This antibody has been found to have utility in assessing routine formalin fixed paraffin-embedded pulmonary neoplasms, as well as the cytopathological evaluation of sputum and bronchial brushings. Recently, it has been shown to be useful in cytological diagnosis of pleural effusions. This study is directed at evaluating its effectiveness in detecting immunoreactive neoplastic cells in body fluids (BF) arising in other tissues. A retrospective cohort of 57 cases was studied, consisting of 36 pleural, 19 ascitic, and 2 pericardial BF. After evaluation of Papanicolaou-stained slides, the BF specimens were immunostained with MCA 44-3A6 using the avidin-biotin-peroxidase complex (ABC) method. In 29 cases, tissue sections of the primary tumors, were also available for immunostaining with MCA 44-3A6. Results showed that 39/42 (93%) of AC BF cases were positive and 28/42 (66%) stained intensely (3-4+) with 75-100% of the AC cells staining in each case. All of the 18 benign and non-AC malignant BF were negative. The staining patterns in the tissue sections of the 29 cases that had corresponding BF samples were similar. We conclude from this study that the MCA 44-3A6 (1) is useful in detecting cells consistent with AC in BF; (2) does not stain inflammatory cells or reactive mesothelial cells, thus helping distinguish reactive from malignant BF; and (3) frequency and pattern of expression in BF parallels its expression in tissue specimens. This study confirms that this MCA is a useful adjunct tool in the cytopathological evaluation of BF.

Adenocarcinoma↗

Resin-process methods for improved isolation of organisms from blood and other body fluids.

Two resin-based processes and conventional culturing methods were compared in isolating organisms from blood specimens of patients given antimicrobial agents. Of 20 patients whose specimens were found to contain clinically relevant organisms, one or both of the resin-process methods isolated organisms in eight after conventional culturing was unsuccessful. Conventional cultures were successful in five cases in which the resin-process methods did not work, and both resin-process and conventional culturing were successful in seven cases. In eight cases in which other body fluids were cultured, only a resin-process method was successful in four, although they are intended for use only with blood specimens. Data indicate that resin-process methods should be used along with conventional culturing methods when patients have already been given an antimicrobial. A review of the literature shows that the devices improve the recovery of organisms but does not establish that detection time is decreased.

Bacteria↗

Microparticle-enhanced nephelometric immunoassay of lysozyme in milk and other human body fluids.

Quantitation of lysozyme in human milk was performed by a microparticle-enhanced nephelometric immunoassay based on the measurement of the light scattered during the competitive immunoagglutination of a microparticle-lysozyme conjugate with an anti-lysozyme antiserum. This immunoassay has a detection limit of 8 microg/L of reaction mixture and can be performed using diluted milk (1:6000, in reaction mixture), excluding sample pretreatment. Human milk lysozyme can be quantified over the concentration range 0.09-1.50 g/L, with within- and between-run coefficients of variation <5%. Changes in the lysozyme concentration of human milk during lactation were determined in 636 samples. Lysozyme concentrations (mean +/- SE) decreased from colostrum (0.36 +/- 0.02 g/L) to transitional milk (0.30 +/- 0.01 g/L) and mature milk during days 15-42 (0.30 +/- 0.01 g/L), then increased in the mature milk during days 43-56 (0.35 +/- 0.01 g/L) and especially during days 57-84 (0.83 +/- 0.05 g/L). The proportion of lysozyme contributing to total protein was found to rise during lactation and was as follows: colostrum (1.7%), transitional milk (2.3%), and mature milk from days 15-28 (2.7%), days 29-42 (3.1%), days 43-56 (3.8%), and days 57-84 (7.3%). The assay developed for milk was also suitable for the determination of lysozyme in other human body fluids.

Adolescent↗

Body fluid markers of cartilage changes in osteoarthritis.

Various markers of the metabolism of articular cartilage have been identified in synovial fluid, blood, and urine of patients with osteoarthritis (OA). The joint fluid level of a cartilage-derived molecule, or its fragment, can be used as a marker of the synthesis or catabolism of that molecule in the articular surfaces within that joint. In blood and urine, on the other hand, the level of a marker is useful in assessing systemic changes affecting the metabolism of a molecule in all the cartilages in the body. Quantification of specific markers in body fluids already has proved useful in identifying increased catabolic as well as anabolic activities in articular cartilage during preradiologic as well as later stages of OA. The markers also can be sued for monitoring the effect of drugs on cartilage matrix molecules and in differentiating among different subtypes of osteoarthritis. Markers should prove most useful in prospective studies aimed at identifying early changes in cartilage metabolism in humans at high risk for developing OA.

Anti-Inflammatory Agents↗