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  • Mechanical ventilation  (4)
  • gallbladder motility  (4)
  • pancreatic polypeptide  (4)
  • Bolus injections  (2)
  • 1
    Electronic Resource
    Electronic Resource
    Function and survival of intrasplenic islet autografts in dogs (1996)
    Springer
    Diabetologia 39 (1996), S. 37-44 
    Details
    ISSN: 1432-0428
    Keywords: Islet of Langerhans ; transplantation ; metabolism ; dog ; glucose-dependent insulinotropic polypeptide ; pancreatic polypeptide
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Successful transplantation of isolated islets of Langerhans has been reported in large mammals, including man, but metabolic control has not been well-established. We studied the glucose and islet hormone response to fasting, i. v. glucose bolus infusion, i.v. arginine bolus infusion during a 35-mmol/l hyperglycaemic clamp, mixed meals, and i. v. insulin-induced hypoglycaemia up to 3 years after intrasplenic islet autotransplantation in six pancreatectomised dogs. The individual postprandial insulinogenic index (ratio of 2-h postprandial insulin to glucose levels) at 1 month post-transplant, predicted (r=0.99) the time to functional graft failure (6–175 weeks). Metabolic studies at 6 months post-transplant in four dogs demonstrated normal fasting glucose and hormone levels, except for reduced pancreatic polypeptide levels. Intravenous glucose and arginine-stimulated insulin were reduced to 15% of preoperative values. In contrast, postprandial normoin-sulinaemia was observed — albeit with moderate hyperglycaemia (approximately 10 mmol/l). Postprandial glucagon and glucose-dependent insulinotropic polypeptide (GIP) had increased. Comparison of the post-transplant insulin responses to a meal and to intravenous challenges demonstrated maximal stimulation of the graft by the meal. Post-transplant pancreatic polypeptide responses to a meal and i.v. arginine were severely reduced, and no pancreatic polypeptide response to i.v. insulin-induced hypoglycaemia was observed — indicating absence of cholinergic reinnervation. Thus, glucose regulation and both the insulin secretory capacity and life expectancy of islet grafts were best documented by meal testing. Tentatively, a postprandial hyperglycaemia-enhanced incretin effect of glucose-dependent insulinotropic polypeptide and other gut hormones may account for the difference in the insulin response to i. v. glucose and a meal. Aside from the reduced insulin secretory capacity, both a deranged pulsatile delivery of insulin, hyperglucagonaemia, and pancreatic polypeptide deficiency may have been conducive to glucose intolerance.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00400411
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  • 2
    Electronic Resource
    Electronic Resource
    Improvement of cardiac output estimation by the thermodilution method during mechanical ventilation (1986)
    Springer
    Intensive care medicine 12 (1986), S. 71-79 
    Details
    ISSN: 1432-1238
    Keywords: Cardiac output ; Flow modulation ; Mechanical ventilation ; Thermodilution method
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The reliability of cardiac output estimation by thermodilution during artificial ventilation was studied in anesthetized pigs at the right side of the heart. The estimates exhibited a cyclic modulation related to the ventilation. The amplitude of the modulation was independent of the level of positive end-expiratory pressure, ventilatory pattern and volemic loading of the animals. However, a non-constant phase relation existed between the ventilatory cycle and the modulation. Single observations at a fixed moment in the ventilatory cycle are therefore not appropriate for estimation of mean cardiac output nor for studying its relative changes. The averaging of estimates spread equally over the ventilatory cycle led to a much larger reduction in the deviation of the averages from the mean cardiac output than an averaging procedure of randomly selected estimates. The accracy of estimation of mean cardiac output by two estimates equally spread in the ventilatory cycle was equal to the accuracy obtained by averaging five randomly selected estimates. Averaging four estimates, equally spread in the cycle, appeared to be the optimal procedure. For 89% of all averages an accuracy of 5% around the mean was obtained and for 99% an accuracy of ±10%.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF00254515
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  • 3
    Electronic Resource
    Electronic Resource
    An adequate strategy for the thermodilution technique in patients during mechanical ventilation (1990)
    Springer
    Intensive care medicine 16 (1990), S. 422-425 
    Details
    ISSN: 1432-1238
    Keywords: Cardiac output ; Mechanical ventilation ; Multiple injections ; Thermodilution
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The application of the thermodilution method in conditions associated with variations in blood flow implies a misuse of the Stewart Hamilton equation. Therefore, we studied the reliability of the thermodilution method for the estimation of mean cardiac output (CO) during mechanical ventilation in patients (n=9). Variation of the injection moment in the ventilatory cycle elicited a cyclic variation of CO estimates. This variation was not the same for all patients neither in phase nor in amplitude. Therefore, no specific phase in the ventilatory cycle could be selected for an accurate estimation of mean CO. Averaging CO estimates randomly distributed in the ventilatory cycle led to an improvement of accuracy with the square root of the number of observations. The averaging of CO estimates spread equally over the ventilatory cycle led to a much better result, e.g., the variation in the average of two estimates equally spread in the ventilatory cycle was similar to the variation in the average of four random estimates. We conclude that averaging of 3 or 4 estimates spread equally over the ventilatory cycle is an adequate strategy to estimate mean cardiac output in patients reliably.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01711218
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  • 4
    Electronic Resource
    Electronic Resource
    A stable model of respiratory distress by small injections of oleic acid in pigs (1996)
    Springer
    Intensive care medicine 22 (1996), S. 336-344 
    Details
    ISSN: 1432-1238
    Keywords: Key words Oleic acid ; Lung injury ; Respiratory distress ; Albumine ; Bolus injections
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract   Objective: Development of a stable model of respiratory distress in pigs with oleic acid, fulfilling clinical criteria of the adult respiratory distress syndrome (ARDS). Design: Eight pigs (9.1±0.7 kg) were anesthetized with pentobarbital, paralyzed with tubocurarine and mechanically ventilated with an FIO2 of 0.6, an I:E ratio of 2:3 and a PEEP of 0.2 kPa. Oleic acid (dissolved 1:1 in 96% alcohol) was administered in a series of multiple injections of 0.1 ml until P aO2 was lower than 8 kPa. Measurements and results: Careful titration of the oleic acid injections on guidance of the P aO2 established a reproducible respiratory distress (P aO2=7.3±0.8 kPa), in which gas exchange and hemodynamic variables were stable for at least 4 h. The number of oleic acid injections (22±11, mean and SD) varied between the animals. Conclusions: With the use of multiple injections of oleic acid, a stable model of early respiratory distress in pigs can be achieved, in spite of individual differences in sensitivity. Such a stable model allows for a diversity of studies on early respiratory distress.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01700456
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  • 5
    Electronic Resource
    Electronic Resource
    A stable model of respiratory distress by small injections of oleic acid in pigs (1996)
    Springer
    Intensive care medicine 22 (1996), S. 336-344 
    Details
    ISSN: 1432-1238
    Keywords: Oleic acid ; Lung injury ; Respiratory distress ; Albumine ; Bolus injections
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective Development of a stable model of respiratory distress in pigs with oleic acid, fulfilling clinical criteria of the adult respiratory distress syndrome (ARDS). Design Eight pigs (9.1±0.7 kg) were anesthetized with pentobarbital, paralyzed with tubocurarine and mechanically ventilated with an $$F_{IO_2 } $$ of 0.6, an I∶E ratio of 2∶3 and a PEEP of 0.2 kPa. Oleic acid (dissolved 1∶1 in 96% alcohol) was administered in a series of multiple injections of 0.1 ml until $$P_{aO_2 } $$ was lower than 8 kPa. Measurements and results Careful titration of the oleic acid injections on guidance of the $$P_{aO_2 } $$ established a reproducible respiratory distress ( $$P_{aO_2 } $$ =7.3±0.8 kPa), in which gas exchange and hemodynamic variables were stable for at least 4 h. The number of oleic acid injections (22±11, mean and SD) varied between the animals. Conclusions With the use of multiple injections of oleic acid, a stable model of early respiratory distress in pigs can be achieved, in spite of individual differences in sensitivity. Such a stable model allows for a diversity of studies on early respiratory distress.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01700456
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  • 6
    Electronic Resource
    Electronic Resource
    Systemic filling pressure in the intact circulation determined with a slow inflation procedure (1996)
    Springer
    Pflügers Archiv 431 (1996), S. 863-867 
    Details
    ISSN: 1432-2013
    Keywords: Venous return ; Central venous pressure ; Inspiratory pause procedures ; Venous capacity ; Venous resistance ; Mechanical ventilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In eight mechanically ventilated, anaesthetized pigs weighing 10.3 ± 0.8 kg (mean ± SD) we studied the effect of the inflation time of the lung on the estimation of the mean systemic filling pressure (P sf) from the changes in venous return and central venous pressure during inflation of the lung. For this purpose we applied slow inflation procedures (SIP) to the lung with inflation times of 2.4, 4.8, 7.2, 9.6 and 12 s at tidal volumes (V T) of 15 and 30 ml/kg. The data were compared with the values ofP sf obtained from inspiratory pause procedures (IPPs). A linear regression between venous return and central venous pressure applied during a SIP underestimatedP sf compared with the value obtained with IPPs. An exponential fit through the values ofP sf obtained from the different SIPs predicted an inflation time of about 15 s for an estimation ofP sf that is not different from theP sf (IPP). The advantage of the SIP method is that theP sf can be determined much faster than with the method based on IPPs. However, due to the rather long inflation time needed, the method may be only applicable under circumstances where neurohumoral control mechanisms are suppressed as during intensive care and anaesthesia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02332170
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  • 7
    Electronic Resource
    Electronic Resource
    Systemic filling pressure in the intact circulation determined with a slow inflation procedure (1996)
    Springer
    Pflügers Archiv 431 (1996), S. 863-867 
    Details
    ISSN: 1432-2013
    Keywords: Key words Venous return ; Central venous pressure ; Inspiratory pause procedures ; Venous capacity ; Venous resistance ; Mechanical ventilation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In eight mechanically ventilated, anaesthetized pigs weighing 10.3 ± 0.8 kg (mean ± SD) we studied the effect of the inflation time of the lung on the estimation of the mean systemic filling pressure (P sf) from the changes in venous return and central venous pressure during inflation of the lung. For this purpose we applied slow inflation procedures (SIP) to the lung with inflation times of 2.4, 4.8, 7.2, 9.6 and 12 s at tidal volumes (V T) of 15 and 30 ml/kg. The data were compared with the values of P sf obtained from inspiratory pause procedures (IPPs). A linear regression between venous return and central venous pressure applied during a SIP underestimated P sf compared with the value obtained with IPPs. An exponential fit through the values of P sf obtained from the different SIPs predicted an inflation time of about 15 s for an estimation of P sf that is not different from the P sf (IPP). The advantage of the SIP method is that the P sf can be determined much faster than with the method based on IPPs. However, due to the rather long inflation time needed, the method may be only applicable under circumstances where neurohumoral control mechanisms are suppressed as during intensive care and anaesthesia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004240050078
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  • 8
    Electronic Resource
    Electronic Resource
    Plasma cholecystokinin and gallbladder responses to intraduodenal fat in gallstone patients (1989)
    Springer
    Digestive diseases and sciences 34 (1989), S. 353-359 
    Details
    ISSN: 1573-2568
    Keywords: plasma cholecystokinin ; cerulein ; gallbladder motility ; cholescintigraphy ; gallstones
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Impaired gallbladder emptying is one of the various factors suggested to be involved in the pathogenesis of gallstones. The present study was undertaken to determine whether gallbladder emptying, endogenous cholecystokinin (CCK) secretion, or their interrelation is altered in patients with gallstones. After intraduodenal administration of 60 ml corn oil, plasma CCK concentration was measured by a sensitive and specific radioimmunoassay and gallbladder emptying by cholescintigraphy. Patients with gallstones (N=20) produced significantly less endogenous CCK (105±17 pmol/liter 60 min; P 〈0.001) than control subjects (191±11 pmol/liter 60 min, N=20); gallbladder emptying in the patients was significantly decreased at 5, 10, 40, 45, and 50 min but the reduction in gallbladder emptying did not reach statistical significance at 60 min (patients 44±8%, control subjects 60±4%). In addition, the gallbladder responsiveness to intravenous infusion of the synthetic CCK analog cerulein was investigated. Based on the results of gallbladder emptying in response to endogenous and exogenous CCK, four subgroups of gallstone patients were identified: (1) a group (N=7) with normal gallbladder sensitivity to CCK, (2) a group (N=6) with significantly increased gallbladder sensitivity to CCK, (3) a group (N=6) with impaired gallbladder emptying after corn oil due to a significantly reduced endogenous CCK secretion but with normal gallbladder sensitivity to CCK, and (4) one patient whose gallbladder was unresponsive to CCK and was found to have chronic cholecystitis at surgery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01536255
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  • 9
    Electronic Resource
    Electronic Resource
    Effect of intravenous glucose on intravenous amino acid-induced gallbladder contraction and CCK secretion (1994)
    Springer
    Digestive diseases and sciences 39 (1994), S. 268-274 
    Details
    ISSN: 1573-2568
    Keywords: hyperglycemia ; amino acids ; parenteral nutrition ; gallbladder motility ; cholecystokinin ; pancreatic polypeptide
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The present study was undertaken to investigate the effect of acute hyperglycemia on the gallbladder contraction induced by intravenous administration of high doses of amino acids (Vamin 18, 250 mg protein/kg/hr). Six healthy volunteers were studied in random order on two occasions during normoglycemia and hyperglycemia with blood glucose levels stabilized at 15 mmol/liter. Gallbladder volumes, measured with ultrasonography, were studied for 60 min before and for 120 min during intravenous infusion of amino acids (IVAA). Administration of IVAA resulted in a significant reduction (P〈0.05) in gallbladder volume from 32±5 cm3 to 17±2 cm3 during normolgycemia. During hyperglycemia no significant changes in gallbladder volume were observed in response to IVAA. No significant changes in plasma CCK concentration, the major hormonal stimulus for gallbladder contraction, occurred in response to IVAA. During hyperglycemia, pancreatic polypeptide (PP) secretion, as an indirect measure of vagal cholinergic tone, in response to IVAA was significantly (P〈0.05) reduced compared to normoglycemia. It is concluded that: (1) administration of high doses of IVAA results in significant gallbladder contraction, (2) high doses of IVAA do not stimulate CCK secretion, (3) acute hyperglycemia inhibits IVAA-induced gallbladder contraction, and (4) acute hyperglycemia inhibits basal and stimulated plasma PP secretion, suggesting impaired vagal-cholinergic tone during hyperglycemia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02090196
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  • 10
    Electronic Resource
    Electronic Resource
    Influence of orlistat on the regulation of gallbladder contraction in man (1996)
    Springer
    Digestive diseases and sciences 41 (1996), S. 2404-2408 
    Details
    ISSN: 1573-2568
    Keywords: orlistat ; tetrahydrolipstatin ; lipase inhibitor ; gallbladder motility ; cholecystokinin
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Orlistat (tetrahydrolipstatin) is a potent inhibitor of gastric and pancreatic lipase activity causing a diminution of free fatty acids in the intestinal lumen. The release of cholecystokinin (CCK) critically depends on the presence of free fatty acids in the small intestine. Postprandial CCK release and gallbladder contraction might be decreased by orlistat, potentially resulting in an increased risk of gallstone formation. In this double-blind, placebo-controlled, six-way crossover study, six healthy volunteers ingested in a randomized order three isocaloric test meals (250 ml) of identical osmolality with either orlistat (200 mg) or placebo: (a) a pure-fat meal (25 g triglycerides), (b) a mixed meal containing fat (8 g; 29% of caloric content), protein (10 g; 17%), and dextrose (32 g; 54%), and (c) a fat-free meal containing albumin (25 g; 46%) and dextrose (32 g; 54%). Gallbladder volumes were determined by ultrasonography, and plasma CCK, pancreatic polypeptide and gastrin levels by RIA. Gallbladder contraction (AUC, % × 90 min; difference of means ± 95% CI) in subjects receiving orlistat or placebo did not significantly differ after intake of the pure-fat meal (443 ± 1174), the mixed meal (313 ± 1170), or the fat-free-meal (−760 ± 1180). The release of CCK (AUC; pM × 90 min; difference of means ± 95% CI) was not different between orlistat and placebo after ingestion of the pure-fat meal (−18 ± 64), the mixed meal (−45 ± 62), and the fat-free meal (27 ± 63). Likewise, the release of pancreatic polypeptide and gastrin was similar after intake of the meals with either orlistat or placebo. A single dose of orlistat did not reduce gallbladder motility after ingestion of meals with differing fat contents. The safety of long-term treatment with orlistat with respect to gallstone formation remains to be determined.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02100135
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