The clinical investigator最新文献_第8页

Impact of long-term hemodialysis on nutritional status in patients with end-stage renal failure. 长期血液透析对终末期肾功能衰竭患者营养状况的影响。

The clinical investigator Pub Date : 1994-10-01 DOI: 10.1007/BF00180542

P Kaufmann, K H Smolle, J H Horina, R Zach, G J Krejs

{"title":"Impact of long-term hemodialysis on nutritional status in patients with end-stage renal failure.","authors":"P Kaufmann, K H Smolle, J H Horina, R Zach, G J Krejs","doi":"10.1007/BF00180542","DOIUrl":"https://doi.org/10.1007/BF00180542","url":null,"abstract":"We evaluated the way in which duration of hemodialysis treatment affects nutritional status in 96 end-stage renal failure patients. According to the length of previous hemodialysis treatment patients were divided into the groups: onset hemodialysis (ON-HD), early-stage hemodialysis (ES-HD, 1-8 months), mid-stage hemodialysis (MS-HD, 9-69 months), and advanced-stage hemodialysis (AS-HD, 70-207 months). Nutritional status was assessed by laboratory data (serum proteins, total lymphocyte count), intradermal skin antigen testing, anthropometric measurements (body mass index [BMI], infrared interactance), and records of food intake. ON-HD patients on a low-protein diet exhibited abnormally low values for serum total protein, albumin, transferrin, and total lymphocyte count and a high prevalence of anergy to skin antigens (69%). In the ES-HD and MS-HD groups values for serum proteins and total lymphocyte count were in the normal range and significantly higher than in ON-HD patients. In addition, a lower proportion of cutaneous anergy was observed (50% and 27%, respectively). Long-term hemodialysis therapy for 6-17 years (AS-HD) was associated with normal levels for all measured serum proteins. Subnormal levels of total lymphocyte count, significantly lower than in MS-HD patients, were associated with an increase in anergy to skin antigens (46%). Serum prealbumin, complement C3c, BMI, body fat, and lean body mass exhibited normal values in all patients and showed no differences between groups. These results indicate that diminished visceral protein stores, lymphopenia, and anergy to skin antigens are widespread in undialyzed uremic patients with end-stage renal failure but become uncommon after the initiation of regular hemodialysis therapy.(ABSTRACT TRUNCATED AT 250 WORDS)","PeriodicalId":22408,"journal":{"name":"The clinical investigator","volume":"72 10","pages":"754-61"},"PeriodicalIF":0.0,"publicationDate":"1994-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF00180542","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18865607","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 22

Carotid artery stenosis and tachyarrhythmias: regional cerebral blood flow during high-rate ventricular pacing after one vessel occlusion in rats. 颈动脉狭窄和快速心律失常:大鼠单根血管闭塞后高速率心室起搏时的局部脑血流。

The clinical investigator Pub Date : 1994-10-01 DOI: 10.1007/BF00180546

A Hagendorff, C Dettmers, P Danos, S Wetter, M Lassau, L Pizzulli, H Omran, T Bauer, A Hartmann, B Lüderitz

{"title":"Carotid artery stenosis and tachyarrhythmias: regional cerebral blood flow during high-rate ventricular pacing after one vessel occlusion in rats.","authors":"A Hagendorff, C Dettmers, P Danos, S Wetter, M Lassau, L Pizzulli, H Omran, T Bauer, A Hartmann, B Lüderitz","doi":"10.1007/BF00180546","DOIUrl":"https://doi.org/10.1007/BF00180546","url":null,"abstract":"The aim of the present study was to investigate the effect of hypotensive tachycardias on cerebral blood flow (CBF) in the presence of significant carotid stenosis. The experiments were performed in 57 spontaneously breathing rats during arterial normoxia and normocapnia anesthetized with thiobarbital. CBF was determined with radiolabeled microspheres during control conditions (normofrequent sinus rhythm, normotension; group A; n = 15), during high-rate left ventricular pacing (660-840 ppm) at normotension (group B1; n = 13), borderline hypotension (group B2; n = 15) and severe hypotension (group B3; n = 7). In addition, CBF measurements were performed during borderline hypotension induced by hemorrhage (group C; n = 7). Global CBF was 1.09 +/- 0.29 ml g-1 min-1 in group A, 0.93 +/- 0.40 in group B1, 0.68 +/- 0.31 in group B2 (P < 0.05 vs. A), 0.42 +/- 0.16 in group B3 (P < 0.05 vs. A) and 0.83 +/- 0.2 in group C. The highest CBF values were found in the cerebellum (A; 1.43 +/- 0.5 ml g-1 min-1) and the lowest in the postocclusive tissue of the ipsilateral hemisphere (A; 0.74 +/- 0.2 ml g-1 min-1). In all groups a 15% mean CBF reduction in the right hemispherical cerebrum in comparison to the left hemisphere was observed (P < 0.01). In contrast, hemispherical CBF of the cerebellum did not differ. The CBF blood pressure relationship shifted to lower CBF values, the threshold of CBF regulation shifted to higher blood pressure values in the tissue regions distal to the occluded vessel during hypotensive tachycardias.(ABSTRACT TRUNCATED AT 250 WORDS)","PeriodicalId":22408,"journal":{"name":"The clinical investigator","volume":"72 10","pages":"775-81"},"PeriodicalIF":0.0,"publicationDate":"1994-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF00180546","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18865611","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 1

Indomethacin treatment in amphotericin B induced nephrogenic diabetes insipidus. 消炎痛治疗两性霉素B所致肾源性尿崩症。

The clinical investigator Pub Date : 1994-10-01 DOI: 10.1007/BF00180544

T Höhler, G Teuber, R Wanitschke, K H Meyer zum Büschenfeld

引用次数: 10

Amanita poisoning during the second trimester of pregnancy. A case report and a review of the literature. 妊娠中期的毒伞中毒。一份病例报告及文献回顾。

The clinical investigator Pub Date : 1994-10-01 DOI: 10.1007/BF00180549

I Nagy, G Pogátsa-Murray, S Zalányi, P Komlósi, F László, I Ungi

{"title":"Amanita poisoning during the second trimester of pregnancy. A case report and a review of the literature.","authors":"I Nagy, G Pogátsa-Murray, S Zalányi, P Komlósi, F László, I Ungi","doi":"10.1007/BF00180549","DOIUrl":"https://doi.org/10.1007/BF00180549","url":null,"abstract":"Amanita phalloides-type mushroom poisoning is well recognized as causing acute liver injury and often death. Less is known, however, of whether maternal Amanita poisoning is associated with fetal damage or not. In August 1991 four members of a family were hospitalized with food intoxication caused by Amanita phalloides and Amanita verna. One of them died from hepatic and renal failure. The survivors included a 26-year-old woman in the 23rd week of pregnancy. Her clinical symptoms and blood chemistry data (lowest prothrombin activity 23%) indicated intoxication of medium severity. The management consisted of i.v. hydration, forced diuresis, and administration of silibinin, high-dose penicillin, thioctic acid, hydrocortisone, vitamin K, and fresh frozen plasma. Sonographic and obstetric controls failed to show any fetal abnormalities in the acute phase of poisoning. In the 38th week of pregnancy she gave birth to a healthy baby, who has subsequently undergone an undisturbed development. This observation indicated that severe fetal damage did not occur in maternal Amanita poisoning in the second trimester of pregnancy. Thus, at least from the second trimester on, maternal Amanita poisoning is not necessarily an indication for induced abortion.","PeriodicalId":22408,"journal":{"name":"The clinical investigator","volume":"72 10","pages":"794-8"},"PeriodicalIF":0.0,"publicationDate":"1994-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF00180549","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18866635","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 12

Low-dose hydrocortisone infusion attenuates the systemic inflammatory response syndrome. The Phospholipase A2 Study Group. 低剂量氢化可的松输注可减轻全身炎症反应综合征。磷脂酶A2研究组。

The clinical investigator Pub Date : 1994-10-01 DOI: 10.1007/BF00180547

J Briegel, W Kellermann, H Forst, M Haller, M Bittl, G E Hoffmann, M Büchler, W Uhl, K Peter

{"title":"Low-dose hydrocortisone infusion attenuates the systemic inflammatory response syndrome. The Phospholipase A2 Study Group.","authors":"J Briegel, W Kellermann, H Forst, M Haller, M Bittl, G E Hoffmann, M Büchler, W Uhl, K Peter","doi":"10.1007/BF00180547","DOIUrl":"https://doi.org/10.1007/BF00180547","url":null,"abstract":"There is increasing evidence that the hypercortisolemia in inflammatory diseases suppresses the elaboration of proinflammatory cytokines, thus protecting the host from its own defence reactions. In severe sepsis and septic shock cortisol levels are usually elevated, but some patients may have relative adrenal insufficiency. This may contribute to the overwhelming systemic inflammatory response syndrome. We evaluated the impact of low-dose hydrocortisone infusion (10 mg/h) on the course of the systemic inflammatory response syndrome. This dose corresponds to a maximum secretory rate of cortisol achieved in corticotropin-stimulated healthy humans. In a prospective observational study 57 surgical patients with severe sepsis or septic shock were studied, of which in addition to the conventional treatment 12 patients were infused with low-dose hydrocortisone, and 45 were treated without any corticosteroid. In the longitudinal analysis the systemic inflammatory response--as judged by body temperature, cardiovascular response, and kinetics of inflammatory mediators such as phospholipase A2, C-reactive protein, and neutrophil elastase--started to differ in favor of the hydrocortisone-treated patients after 2 days of treatment (P < 0.05, Mann-Whitney U test). The difference disappeared after withdrawal of exogenous cortisol. Shock reversal was achieved in all patients treated with low-dose hydrocortisone. The data provide evidence that low-dose hydrocortisone infusion attenuates the systemic inflammatory response in human septic shock. From an immunological point of view a relative cortisol deficiency may contribute to the amplified immune response in systemic inflammatory diseases. A randomized clinical trial must clarify the impact of low-dose hydrocortisone infusion on the clinical course and outcome of septic shock patients.","PeriodicalId":22408,"journal":{"name":"The clinical investigator","volume":"72 10","pages":"782-7"},"PeriodicalIF":0.0,"publicationDate":"1994-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF00180547","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18865612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 113

Localization of the bronchodilator effect induced by type A natriuretic peptide in asthmatic subjects. A型利钠肽对哮喘患者支气管扩张作用的定位。

The clinical investigator Pub Date : 1994-10-01 DOI: 10.1007/BF00180545

T Flüge, H Fabel, T O Wagner, W G Forssmann

引用次数: 0

Pituitary and adrenal hormone responses to pharmacological, physical, and psychological stimulation in habitual smokers and nonsmokers. 习惯性吸烟者和非吸烟者的垂体和肾上腺激素对药理学、生理和心理刺激的反应。

The clinical investigator Pub Date : 1994-10-01 DOI: 10.1007/BF00180552

C Kirschbaum, G Scherer, C J Strasburger

{"title":"Pituitary and adrenal hormone responses to pharmacological, physical, and psychological stimulation in habitual smokers and nonsmokers.","authors":"C Kirschbaum, G Scherer, C J Strasburger","doi":"10.1007/BF00180552","DOIUrl":"https://doi.org/10.1007/BF00180552","url":null,"abstract":"Hormone responses to injection of corticotropin-releasing hormone following bicycle ergometry and psychological stress were studied in ten habitual smokers and ten nonsmokers. Compared to injection of saline, significant increases were found in adrenocorticotropin, prolactin, growth hormone, total serum cortisol, and salivary cortisol under all three stimulations except for salivary cortisol under ergometry. Furthermore, the smokers showed significant elevations of all five hormones investigated following the smoking of two cigarettes of the subject's preferred brand. Comparisons of hormone responses between smokers and nonsmokers revealed a general trend towards stronger responses in nonsmokers. However, due to the small number of subjects investigated and considerable variation in the individual hormone responses these differences reached statistical significance only for growth hormone responses following ergometry and salivary cortisol responses after psychological stress. In addition, the circadian rhythm of salivary cortisol was measured on two occasions between 9 a.m. and 9 p.m. in the subject's natural environment. The typical circadian pattern of decreasing cortisol levels was observed, with no significant differences between smokers and nonsmokers. We conclude that chronic nicotine consumption may lead to lower responses of multiple hormones not only to nicotine but to a variety of stimuli, and that these alterations do not necessarily affect unstimulated circadian profiles of free cortisol.","PeriodicalId":22408,"journal":{"name":"The clinical investigator","volume":"72 10","pages":"804-10"},"PeriodicalIF":0.0,"publicationDate":"1994-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF00180552","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18866638","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 98

Circulating adhesion molecules ICAM-1, VCAM-1 and E-selectin in systemic vasculitis: marked differences between Wegener's granulomatosis and systemic lupus erythematosus. 系统性血管炎循环粘附分子ICAM-1、VCAM-1和e -选择素:韦格纳肉芽肿病与系统性红斑狼疮的显著差异

The clinical investigator Pub Date : 1994-10-01 DOI: 10.1007/BF00180543

C Mrowka, H G Sieberth

{"title":"Circulating adhesion molecules ICAM-1, VCAM-1 and E-selectin in systemic vasculitis: marked differences between Wegener's granulomatosis and systemic lupus erythematosus.","authors":"C Mrowka, H G Sieberth","doi":"10.1007/BF00180543","DOIUrl":"https://doi.org/10.1007/BF00180543","url":null,"abstract":"Inflammatory systemic disorders with renal tissue damage require the adherence of polymorphonuclear leukocytes to the endothelium, which is mediated by cell surface adhesion molecules. This study measured the serum concentrations of circulating adhesion molecules [intercellular adhesion molecule 1 (cICAM-1), vascular cell adhesion molecule 1 (cVCAM-1), cE-selectin] by sandwich enzyme-linked immunosorbent assay in Wegener's granulomatosis (n = 25) and systemic lupus erythematosus (n = 50). Active Wegener's granulomatosis with cellular crescent formation was associated with significantly raised cICAM-1 levels, an elevated histological activity index, and a high rate of hemodialysis in comparison to Wegener's granulomatosis with fibrocellular crescents or lupus nephritis. The activity index and cICAM-1 levels can be used as parameters to predict renal outcome in Wegener's granulomatosis. cVCAM-1 levels in Wegener's granulomatosis were significantly higher in patients with hemodialysis compared to those without hemodialysis. In lupus nephritis only cVCAM-1, not cICAM-1 or cE-selectin, were significantly higher (P < 0.01) than controls. cVCAM-1 levels in both diseases were significantly higher than in controls. Only in Wegener's granulomatosis did cICAM-1 and cVCAM-1 levels decrease with clinical remission; in systemic lupus erythematosus the levels remained unchanged. cE-selectin levels were not significantly elevated in systemic vasculitis or collagen disease although individual patients revealed high serum concentrations. These data suggest that levels of circulating adhesion molecules reflect different pathophysiological processes in systemic vasculitis and collagen disease and may be used as markers of disease activity and renal outcome.","PeriodicalId":22408,"journal":{"name":"The clinical investigator","volume":"72 10","pages":"762-8"},"PeriodicalIF":0.0,"publicationDate":"1994-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF00180543","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18539118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 24

Evidence for autoimmune mechanisms in the evolution of invasive fibrous thyroiditis (Riedel's struma). 侵袭性纤维性甲状腺炎(里德尔瘤)发展过程中自身免疫机制的证据

The clinical investigator Pub Date : 1994-10-01 DOI: 10.1007/BF00180548

A E Heufelder, I D Hay

{"title":"Evidence for autoimmune mechanisms in the evolution of invasive fibrous thyroiditis (Riedel's struma).","authors":"A E Heufelder, I D Hay","doi":"10.1007/BF00180548","DOIUrl":"https://doi.org/10.1007/BF00180548","url":null,"abstract":"The etiology of Riedel's invasive fibrous thyroiditis, a rare disorder confused in the past with the more common fibrous variant of Hashimoto's disease, has remained obscure. However, the presence of mononuclear cells in the fibrosclerotic process and the detection of autoantibodies directed against thyroid-specific antigens in a large proportion of patients with invasive fibrous thyroiditis favor an autoimmune pathogenesis of invasive fibrous thyroiditis. Further, an association between invasive fibrous thyroiditis and Hashimoto's thyroiditis has been suggested. Here we report the first two patients in whom invasive fibrous thyroiditis evolved from antecedent Graves' disease, documented by the presence of thyroid dysfunction, bilateral ophthalmopathy, and thyrotropin receptor stimulating autoantibodies. The diagnosis of invasive fibrous thyroiditis was established in both instances on the basis of the established histopathological criteria. The presence of extensive mononuclear cell infiltration within the invasive fibrosclerotic process in these two patients, the close relationship between thyroid-specific autoantibodies, inflammatory parameters, and disease activity, and the response to glucocorticoid therapy all suggest the existence of a link between Graves' disease and invasive fibrous thyroiditis. These findings support the notion of autoimmune mechanisms playing a role in the pathogenesis of Riedel's invasive fibrous thyroiditis.","PeriodicalId":22408,"journal":{"name":"The clinical investigator","volume":"72 10","pages":"788-93"},"PeriodicalIF":0.0,"publicationDate":"1994-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/BF00180548","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"18865613","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 31

International Symposium on Sodium and Hypertension. Results of randomized trials. 钠与高血压国际研讨会。随机试验的结果。

The clinical investigator Pub Date : 1994-10-01 DOI: 10.1007/BF00180551

S Heyden, R Kluthe, C Immenhofer

引用次数: 1