M. Lykkegaard Nielsen

Trimethoprim in Normal and Pathological Human Lung Tissue

Following oral administration of trimethoprim (TMP) in doses varying from 5.7 to 9.8 mg TMP per kg body weight per 24 h over a period of 1–22 days, the concentration was determined in normal and patho

Wound sepsis after elective cholecystectomy. Restriction of prophylactic antibiotics to risk groups.

This prospective study of elective cholecystectomy investigated the frequency and type of bacteria in gallbladder bile at operation, the factors predicting the presence of bacteria in bile, and the relationship between bacteria in bile and subsequent wound sepsis. In 148 consecutive cases 23% of bile cultures were positive. The overall wound infection rate was 15%, but 91% of all wound infections occurred in patients with positive bile cultures. Eighty-five per cent of all positive bile cultures and 86% of all wound infections occurred in 37% of the patients, characterized by age over 60 years and/or a history of previous attacks of acute cholecystitis. We suggest that in elective cholecystectomy prophylactic antibiotics should be restricted to this group of patients to limit the use of antibiotics.

Routine measurements of liver and bone alkaline phosphatase in human serum: Differential inhibition by l-phenylalanine and carbamide (urea) on the LKB 8600 reaction rate analyzer

Abstract A method suitable for routine determination of liver and bone alkaline phosphatase (EC 3.1.3.1) on the LKB 8600 is described. Experimental data on differential inhibition by l -phenylalanine, 10 mmoles/1 and carbamide, 3.81 moles/1 under strictly controlled conditions on the LKB 8600 are given. Data on the stability of the tissue alkaline phosphatase extracts and on the precision of the analytical system are provided. The method permits the determination of 15 samples per h.

Excretion, Deconjugation, and Absorption of Bile Acids after Colectomy for Ulcerative Colitis: Comparative Studies in Patients with Conventional Ileostomy and Patients with Kock's Reservoir

Bile acid metabolism was studied in 26 patients with a continent ileostomy (Kocks reservoir) and 32 patients with conventional ileostomy. All had been colectomized for ulcerative colitis. In patients with a continent ileostomy the 14C-glycocholic acid breath test showed increased pulmonary 14CO2 excretion as evidence of abnormal bacterial deconjugation of bile acids and increased faecal 14C excretion as evidence of bile acid malabsorption. Faecal bile acid excretion, determined chemically, and, by inference, bile acid synthesis were only moderately increased (median, 1.8 mmol/day). The disturbance of bile acid metabolism was similar to that found in 32 patients with conventional ileostomy, but more pronounced with higher faecal 14C. A significant difference was that no abnormal bacterial deconjugation took place in patients with conventional ileostomy, since their pulmonary 14CO2 excretion was subnormal. Stool mass was almost identical in the two groups, with median values of 665 and 663 g/day, respectively. Faecal fat excretion was normal in most in both groups. Thus bile acid metabolism is slightly more disturbed in patients with a continent ileostomy than in patients with conventional ileostomy. The resulting malabsorption was modest in both groups.

Bacterial Flora of the Small Intestine and Bile Acid Metabolism in Patients with Hepatico-Jejunostomy Roux-en-Y

Duodenal and jejunal bacterial flora and bile acid metabolism were investigated in 14 patients with hepatico-jejunostomy Roux-en-Y. Anaerobic culture procedures were based on the use of a glove-box with an oxygen-free atmosphere and pre-reduced, anaerobically sterilized media. Anaerobic transport was based on evacuation of atmospheric air from transport-tubes and transport-time less than 30 minutes. Bile acid metabolism was evaluated from concentrations of toal bile acids and deconjugated bile acids, glycine/taurine ratio and breath test. In 92 per cent of the patients an abnormal flora-containing anaerobic and/or aerobic bacteria was found in the most proximal part of the jejunum at the site of the entero-entero anastomosis (cf. Fig. 1 and Table 1). Total bile acid concentrations were low in half of the patients, whereas deconjugated bile acids or elevated glycine/taurine ratio was found in one patient only (cf. Table II). An abnormal breath test was found in 5 patients, but without any clear correlation between the breath test and the bacterial flora.

Clinical evaluation of routine measurement of liver and bone alkaline phosphatases in human serum. Differential inhibition by L-phenylalanine and carbamide (urea) on the LKB 8600 reaction rate analyzer.

Abstract Determination of liver and bone alkaline phosphatase in human serum was carried out with a recently developed routine method using differential inhibition by l -phenylalanine and carbamide on the LKB 8600. Three groups of patients were investigated: 71 patients with hepato-biliary disorders, 22 patients with bone diseases, and 67 patients without recognizable hepato-biliary or bone diseases. Agreement between the clinical diagnosis and the separate values of liver AP and bone AP was found in patients with elevated total alkaline phosphatase activities in serum.

Experimental animal model of surgical wound infection applicable to antibiotic prophylaxis.

Wound infection, defined as accumulation of pus draining spontaneously or after opening of the Wound, developed in 19 out of 22 guinea pigs (86 %) after intraincisional contamination with 107Escherichia coli plus 108Bacteroides fragilis before wound closure. Antibiotic prophylaxis with gentamicin plus clindamycin significantly reduced the wound sepsis rate from 86 % to 29 % (p<0,001). Pus for bacteriological studies was available in all cases of wound infection but one, and culture always revealed bothEscherichia coli andBacteroides fragilis. The animal model Presented employs widely accepted criteria for wound infection, and avoids culture of tissue homogenates.

Release of Gastric Inhibitory Polypeptide and Insulin in Response to Intrajejunal Glucose in Duodenal Ulcer Patients before and after Truncal Vagotomy

Six duodenal ulcer patients were investigated before and 3 months after truncal vagotomy and pyloroplasty. Plasma concentrations of gastric inhibitory polypeptide (GIP), insulin, and glucose were measured during intrajejunal infusion of 50 g of glucose. The GIP response was significantly diminished postoperatively; insulin and glucose concentrations, however, were unchanged. The reduction of GIP release was positively correlated with the reduction of the peak acid output. The results suggest that a reduced vagal innervation of the intestine is accompanied by reduced GIP release after intrajejunal glucose, depending on the degree of completeness of vagotomy.

The Penetration of Lincomycin into Normal Human Bone: Determinations of Penetration into Compact Bone, Spongy Bone and Bone Marrow

The penetration of lincomycin into normal bone was studied in 10 patients with fracture of the neck of the femur, a separate determination being made of the lincomycin concentration in serum, bone marrow, spongy bone and compact bone. The concentration of lincomycin in bone marrow was found to be at the same level as that in the serum. The concentration in spongy bone amounted in most cases to 50 to 75 percent of the concentration in the serum, whereas the concentration in compact bone varied from 0 to 15 percent of that in the serum.

Wound infection rates after intraincisional plus systemic antibiotic prophylaxis in an animal model.

The effect of intraincisional application of antibiotics in addition to systemic antibiotic prophylaxis was evaluated in a randomized blind study using a guinea pig model of surgical wound infection. Wounds were contaminated with 107Escherichia coli plus 108Bacteroides fragilis. Wound infection was defined as accumulation of pus draining spontaneously or after opening the wound. Systemic antibiotic prophylaxis with gentamicin plus clindamycin significantly reduced the wound sepsis rate from 83% in the control group to 20% in the treated group (p < 0.001). Intraincisional application of antibiotics in addition to systemic prophylaxis did not further reduce the rate of wound sepsis (p > 0.8).