Plasma fibronectin concentration in suspected septicaemia is related to severity of sepsis.

Low plasma fibronectin levels have been reported in patients with septic complications following surgery, major trauma or burn injury. Our purpose was to evaluate fibronectin in suspected septicaemia and its relationship to severity of infection and clinical outcome. In 51 consecutive patients with infection classified as mild (group A), severe (group B) or severe complicated by septic shock, disseminated intravascular coagulation or multiple organ failure (group C), the respective mean initial fibronectin concentrations were 85% +/- 10 (SD), 55% +/- 15 and 44% +/- 13 of the reference mean (0.

A hemodynamic profile diagram and its application in septic patients.

A physiologic profile is presented in the form of a circular diagram, in which hemodynamic parameters, oxygen uptake and arterial lactate are displayed on 12 radial spokes. Results are presented as per cent of reference values. In the normal state the profile will be evenly circular, while different circulatory disturbances present typical patterns.

Changes in nutritional assessment variables caused by total parenteral nutrition in anorexia nervosa.

Nutritional assessment variables were measured weekly in 10 young women with severe anorexia nervosa during treatment with total parenteral nutrition (TPN) for a 5 week period. Before the start of treatment the patients had lost 25-53% of their habitual weight, triceps skin fold (TSF) and arm muscle circumference (AMC) measurements were below the 5th percentile and all were anergic in the delayed hypersensitivity (DH) response. Plasma protein levels were normal except in fibronectin and prealbumin where levels below the reference interval was found in five patients.

Metabolic effects of amino acid solutions in severely burned patients: with emphasis on sulfur amino acid metabolism and protein breakdown.

The metabolic effects of TPN containing high amounts of amino acids (18 gm N) was evaluated with respect to sulfur amino acid metabolism and protein breakdown in nine severely burned patients. The results were compared to corresponding data from burned patients receiving more moderate amounts of amino acids (9.2 gm N) or isocaloric amounts of carbohydrate and fat.

Severe anorexia nervosa treated with total parenteral nutrition. Clinical course and influence on clinical chemical analyses.

Severe anorexia nervosa in which psychiatric treatment has failed is a life-threatening condition since the degree of emaciation can be profound. Nine young women with a weight loss of 25-50% of their habitual weights were given total parenteral nutrition (TPN) over 3-8 weeks through a tunneled central venous silicone catheter. They initially received a mean of 55 kcal/kg body weight/24 hours increasing to 65-70 kcal/kg body weight during the first week.

Kinetics of morphine in cerebrospinal fluid after epidural administration.

Forty patients undergoing arthroscopy were given an epidural dose of 0.05 mg morphine-HCl in 0.1 ml saline/kg body weight to study the disposition of morphine in the cerebrospinal fluid (CSF).

Influence of total parenteral nutrition on plasma fibronectin in malnourished subjects with or without inflammatory response.

Plasma fibronectin, which is an alpha 2-glycoprotein of importance for the immunodefence, has been reported to decrease after starvation and in severely ill patients with cancer. To evaluate the usefulness of fibronectin as an indicator of nutritional repletion, 18 patients with gastrointestinal disorders were studied over a 2-wk period of total parenteral nutrition (TPN). According to nutritional assessment on admission the patients were divided into well nourished (n = 6) and malnourished (n = 12).

Muscle and plasma carnitine levels and urinary carnitine excretion in multiply injured patients on total parenteral nutrition.

Carnitine is necessary for the transport of long-chain fatty acids across the mitochondrial membrane. Thirteen severely injured patients on total parenteral nutrition were studied during days 2-8 post injury. Initially plasma and skeletal muscle carnitine values were within the range earlier found for normal subjects, whereas the urinary carnitine excretion was markedly increased.

Effects of the extradural administration of morphine, or bupivacaine, on the endocrine response to upper abdominal surgery.

The endocrine response, and the relief of pain, following the extradural administration of morphine or a local anaesthetic agent bupivacaine (0.5%) were studied for 24h after abdominal surgery and compared with a control group given conventional i.v.

Thyroid hormones, catecholamine and cortisol concentrations after upper abdominal surgery.

Serum and plasma concentrations of thyroid hormones, catecholamines and cortisol as well as oxygen consumption were measured simultaneously in twenty patients in connection with cholecystectomy. Arterial blood samples were taken before surgery and at 2, 24, 48, 72 and 96 h after skin incision. A marked and prolonged decrease in T3 and free T3 concentrations was seen.

Low plasma fibronectin indicates septicaemia in major burns.

Plasma fibronectin was measured by laser nephelometry in 23 patients with 20--85% burns. Control measurements were made in 118 healthy blood donors aged 18--60 years. The reference level was significantly higher in the 72 males (mean +/- SD = 377 +/- 70 mg/l) than in the 46 females (327 +/- 55 mg/l).

The effect of severe trauma on muscle energy metabolism in man.

Muscle energy metabolism after severe trauma was studied in four nutritionally isocaloric groups of patients, receiving different amounts of glucose, fat and nitrogen. Muscle biopsy was performed 2, 4, 8 and 30 days after trauma. The pattern of energy metabolites was similar in all groups.

Nutritional assessment reflects muscle energy metabolism in gastric carcinoma.

Preoperative nutritional status and muscle energy metabolism were studied in 26 patients with gastric carcinoma. Fat stores were reduced in 30% and visceral proteins in 25% to 90% of the patients. According to the nutritional assessment, the patients were divided into well-nourished (group I, n = 8) with no or minor signs of malnutrition and malnourished (group II, n = 13) with signs of pronounced malnutrition.

Metabolic changes in a case of malignant hyperthermia.

A patient with fulminant MH is presented. The metabolic changes in muscle tissue, whole blood and plasma are compared with those obtained from the porcine model. The samples were taken 1 h after treatment (including dantrolene sodium) had been commenced.

Metabolic effects of four intravenous nutritional regimens in patients undergoing elective surgery II.--Muscle amino acids and energy-rich phosphates.

Muscle amino acids and energy-rich phosphates have been determined in 28 patients before and after resection of a carcinoma of colon or rectum. Before operation the patients received a synthetic diet (Vivasorb for four days and postoperatively four different intravenous regimens with different amounts and proportions of amino acids were given for six days, the energy intake being the same for all groups. When compared with age-matched healthy controls the patients showed only slight increases in phenylalanine and isoleucine concentration in muscle and plasma with elevated plasma glutamate during the four days prior to the operation.

Urinary excretion of carnitine in multiply injured patients on different regimens of total parenteral nutrition.

Carnitine derives from intake of preformed exogenous carnitine and synthesis from lysine and methionine, but is absent in parenteral fluids. Urinary excretions of carnitine and its derivatives was measured in 30 patients 2-8 days after severe multiple injuries and compared with controls. The patients received five different isocaloric parenteral nutritional regimens;group 1 glucose and fat, group 2 glucose, fat and amino acids, group 3 glucose and insulin, group 4 glucose and amino acids, and group 5 branched-chain amino acids.

Metabolic effects of four intravenous nutritional regimens after elective surgery. I. Clinical data and biochemistry.

Biochemical variables have been determined in 28 patients before and after resection of carcinoma of colon or rectum. A synthetic oral diet was given for four days before operation, (0.1 gN.

Delayed hypersensitivity. A critical evaluation of five recall antigens in a large reference population.

The reactivity to five recall antigens, candida, mumps, PPD, varidase and trichophyton and the corresponding diluents was tested in 840 healthy persons aged between 17 and 101 years. Candida antigen was tested in a lower (l) and a higher (h) dose. The size of reactions did not follow a Gaussian distribution and we therefore used the 10th and 5th percentiles instead of standard deviation to define the limits between positive, weak and negative reactions.

Nutritional assessment and clinical course in 112 elective surgical patients.

Recent Swedish reference values in anthropometry and delayed hypersensitivity (DH) were applied in the nutritional assessment of 112 surgical patients. The presence of three or more subnormal variables indicating malnutrition was found in 28% of all patients, and in 52% of those with malignant disease. The anthropometric variables revealed deficits in fat stores and muscle in 26 and 6%, respectively.

Extradural and parenteral morphine: kinetics and effects in postoperative pain. A controlled clinical study.

In a controlled clinical study of 20 patients undergoing arthrotomy a single dose of morphine 0.05 mg kg-1 administered extradurally resulted in more pronounced and prolonged pain relief than morphine 0.1 mg kg-1 i.

Urinary excretion of sulfur amino acids and sulfur metabolites in burned patients receiving parenteral nutrition.

The urinary excretion of sulfur-containing compounds was studied in 11 burned patients during the first 10 days after injury. They were all given carbohydrate and fat by parenteral nutrition. Two patients also received large amounts of amino acids including methionine, whereas five patients were given amino acids including moderate amounts of methionine and cysteine.

Long term parenteral therapy by percutaneous tunneled silicone central venous catheter--a follow-up of 300 catheters.

We have developed a technique for the management of central venous catheters which incorporates percutaneous insertion and daily care for routine use in different wards. A follow-up of the first 300 catheters is presented. When intravenous therapy was planned for more than two weeks, a silicone rubber catheter was introduced percutaneously with a skin tunnel and the position of the tip in the lower superior vena cava checked by venous pressure measurement.

Adverse effects of extradural and intrathecal opiates: report of a nationwide survey in Sweden.

The Swedish Society of Anaesthetists conducted a nationwide retrospective survey of clinical experience with extradural and intrathecal opiates. Special interest was focused on the frequency and type of ventilatory depression. The questionnaire was answered by 84 of 93 departments (90%).