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Biomedical subjects

B A Zarkin

Publications and source records attributed to B A Zarkin.

5 recordsLinked to original sources
PubMed1992

Patients with uncomplicated cholelithiasis acidify bile normally.

Reports have suggested that patients with gallstones have gallbladder bile that is less acidic and more saturated with calcium carbonate than patients without gallstones. This failure to acidify bile may play a role in the formation of gallstones. We, therefore, compared gallbladder bile pH, ionized calcium, and calcium carbonate saturation index from patients undergoing either incidental gallbladder removal (controls, n = 23) or elective cholecystectomy for gallstones (n = 55). Gallstones were classified as either cholesterol (n = 39) or black pigment (n = 16) stones. No difference in gallbladder bile pH was noted among the controls, cholesterol stone, and pigment stone patients. In addition, no difference in ionized calcium concentration or CCSI was noted among the three groups. The pH in additional patients (n = 49) with acute cholecystitis, common bile duct obstruction, biliary tract infection, and cystic duct obstruction was significantly more acidic. We conclude that neither a defect in bile acidification nor increased saturation of calcium carbonate explains why human cholesterol or pigment gallstones form.

Adult↗
PubMed1990

The triad of Streptococcus bovis bacteremia, colonic pathology, and liver disease.

The association of Streptococcus bovis endocarditis and colon carcinoma has been reported previously in small series in the medical, but not surgical, literature. Although the fecal carriage rate of S. bovis increases with colonic pathology, no explanation exists for the development of bacteremia in these cases. To explore the possible contribution of hepatic dysfunction to the development of portal and systemic bacteremia, the incidence of both colonic pathology and liver disease or dysfunction was determined in 92 patients with S. bovis endocarditis and/or bacteremia. Colonic and liver evaluation had been undertaken in 47% and 93% of patients, respectively. Among these patients, colonic pathology was identified in 51%, and liver disease or dysfunction was documented in 56%. Either the underlying colonic disease or alterations in hepatic secretion of bile salts or immunoglobulins may promote the overgrowth of S. bovis and its translocation from the intestinal lumen into the portal venous system. A compromised hepatic reticuloendothelial system may then contribute to the development of S. bovis septicemia and subsequent endocarditis. We conclude that S. bovis bacteremia is an indication to the clinician of the possibility of underlying liver disease as well as colon pathology.

Colonic Diseases↗
PubMed1989

Short-term outcomes of elderly patients discharged from an emergency department.

To determine the short-term functional and medical outcomes and predictors of outcome following discharge from an acute hospital emergency department, 100 elderly (greater than or equal to 65 yr) and 100 nonelderly (less than 65 yr) patients were studied prospectively. Patients were interviewed at three days and again at three weeks following emergency department discharge. The number of new prescriptions given to both groups in the emergency department was similar (elderly 41%; nonelderly, 31%). The elderly were as likely as the nonelderly to know the correct name (elderly, 88%; nonelderly, 87%), dosage schedule (elderly, 90%; nonelderly, 90%) and purpose (elderly, 85%; nonelderly, 94%) of their new medications. There was no difference in patients' understanding of the diagnosis (elderly, 72%; nonelderly, 72%) or in medication compliance (elderly, 81%; nonelderly, 74%). Elderly patients were more likely to keep scheduled follow-up appointments (87% vs 65%; P less than .05). Despite these similarities the elderly had worse medical outcomes at three weeks; 67% of the elderly were better and 20% were worse, including seven patients who required interim hospitalization, four of whom died. In contrast, 82% of the nonelderly were better and only 4% were worse (P less than .01). None of the nonelderly required hospitalization or had died. Functional impairments were more common in the elderly both at baseline (elderly, 26%; nonelderly, 6%; P less than .01) and at three weeks (elderly, 27%; nonelderly, 5%; P less than .001). Independent predictors of poor medical outcome included age greater than or equal to 65 (P less than .009) and functional impairment at baseline (P less than .022).(ABSTRACT TRUNCATED AT 250 WORDS)

Activities of Daily Living↗