PubMed Health⌕ Search

Biomedical subjects

D Gadaleta

Publications and source records attributed to D Gadaleta.

17 recordsLinked to original sources
PubMed1997

Portal vein gas, a changing clinical entity. Report of 7 patients and review of the literature.

OBJECTIVE: To assess the clinical significance of portal vein gas (PVG) demonstrated by computed tomography (CT). DESIGN: Review of medical records. SETTING: Three network-affiliated hospitals providing both primary community-based and tertiary services. METHODS: Review of diagnosis, clinical circumstances, and significance of PVG in 7 patients detected by CT during a 3-year period in 3 affiliated hospitals. RESULTS: Four of 7 patients underwent laparotomy; 1 patient refused surgery. Two patients were treated with intravenous antibiotics only and had uneventful clinical courses. Of the 3 patients who died, 1 refused and 2 underwent laparotomy. CONCLUSIONS: This series indicates that more sensitive imaging and more widespread use of endoscopic retrograde cholangiopancreatography, colonoscopy, and liver transplantation have changed the clinical presentation of PVG; PVG may be found in various clinical settings that do not mandate laparotomy; and the significance of PVG must be derived from the clinical context of the individual patient.

Adult↗
PubMed1996

Surgical Infection Society position on vancomycin-resistant Enterococcus.

The risk of transfer of vancomycin resistance to staphylococci is a real possibility and has been achieved in the laboratory. Prolonged colonization occurs with vancomycin-resistant Enterococcus (VRE), and many more patients are colonized than infected. The failure to identify, isolate, and adhere to infection control measures when caring for VRE-colonized patients dooms to failure any means to control its spread. Control of vancomycin use alone is unlikely to greatly affect the number of patients at risk for VRE colonization. The global spread of VRE may be impossible to stop, but infection control measures are the most important line of defense inside hospitals.

Anti-Bacterial Agents↗
PubMed1994

Inhibition of neutrophil leukotriene generation by the 21-aminosteroid, U-74389F.

The 21-aminosteroids are potent inhibitors of iron-dependent lipid peroxidation and more protective than methylprednisolone in models of trauma and reperfusion, but without glucocorticosteroid side effects. Histologically, animals treated with 21-aminosteroids have decreased neutrophil (PMN) infiltrates and diminished tissue destruction associated with trauma or reperfusion. Since PMN contribute to organ failure following ischemia-reperfusion, we assessed the effect of U-74389F (U7), on normal PMN function. Neutrophils from normal volunteers were incubated for 90 min with either vehicle, 15 microM U7 or 80 microM methylprednisolone (MP), in DMSO. Lactoferrin released and generation of leukotrienes to calcium ionophore A23187, also oxygen consumed to PMA and leukotriene B4 (LTB4) and chemotaxis to FMLP and LTB4, were determined for each group of PMN. Lactoferrin released to A23187 was significantly decreased in both steroid groups (7.29 +/- 0.82 micrograms vs 3.06 +/- 0.57 micrograms U7 and 2.88 +/- 0.62 micrograms MP, P < 0.01). PMN incubated with U7 or MP generated significantly less LTB4 (60.6 +/- 4.3 ng vs 47.7 +/- 2.4 ng U7 and 43.3 +/- 5.6 ng MP, P < 0.05). There were no differences noted in the ability of PMN incubated with either compound to consume oxygen or to respond to chemotactic stimuli. We conclude that the proven protective action of the 21-aminosteroids in models of ischemia-reperfusion is related to the ability of "steroids" to inhibit leukotriene generation and degranulation and may be related to the prevention of tissue lipid peroxidation by scavenging oxygen radicals.

Antioxidants↗
PubMed1994

Neutrophil leukotriene generation increases after cardiopulmonary bypass.

BACKGROUND: Leukotriene B4 has been shown to play a role in the systemic inflammatory response after cardiopulmonary bypass in experimental animal models; however, the importance of this mediator in human beings undergoing cardiac operations has not been established. METHODS: The neutrophils of ten patients undergoing coronary artery bypass grafting with cardiopulmonary bypass were studied for their ability to generate leukotrienes at the time of the induction of anesthesia, the institution of cardiopulmonary bypass, the removal of the aortic crossclamp, at the end of the operation, on admission to the intensive care unit, and on postoperative days 1 and 2 RESULTS: After cardiopulmonary bypass, the generation of chemotactic leukotrienes rose significantly and remained elevated on the first postoperative day compared with prebypass values (prebypass 133.8 +/- 10.7 versus postbypass 192.7 +/- 19.2 [p < 0.05] and first postoperative day 196.6 +/- 13.8 [p < 0.05]). The increases in plasma complement and lactoferrin levels, although significant, were not sustained. In addition to the neutrophil count, the potential leukotriene and oxygen radical produced was significantly increased, and this increase was correlated with postoperative length of stay. CONCLUSION: These observations support the laboratory data documenting that the rise in leukotriene generation after cardiopulmonary bypass includes human patients.

Aged↗
PubMed1994

Neutrophil leukotriene generation and pulmonary dysfunction after abdominal aortic aneurysm repair.

BACKGROUND: The purpose of this study was to assess the role of polymorphonuclear neutrophil (PMN)-generated leukotriene B4 (LTB4) as an etiologic agent in the pulmonary dysfunction seen after operation in patients undergoing abdominal aortic aneurysm repair. METHODS: Blood was analyzed in 10 consecutive patients undergoing elective infrarenal abdominal aortic aneurysm repair for plasma thromboxane B2, lactoferrin, C3a, and PMN-generated LTB4. RESULTS: There was a close linear correlation (r = 0.88; p < 0.001) between aortic clamp time and PMN LTB4 production. Conversely, aortic clamp time and the ratio of arterial oxygen pressure to fraction of inspired oxygen, a measure of pulmonary function, were inversely related (r = -0.80; p < 0.008). PMNs from patients with long aortic cross-clamp times generated three times more LTB4 than those patients with short cross-clamp times (194 +/- 29.6 vs 64.9 +/- 9.7 ng per 5 x 10(6) PMN; p < 0.05). Similarly, the pressure/inspired oxygen ratio was significantly lower on admission to the intensive care unit in patients with long cross-clamp times as compared with patients with short cross-clamp times (237 +/- 14 vs 342 +/- 5; p < 0.005). In addition, patients with long cross-clamp times remained intubated longer than patients with short times (1.6 +/- 0.2 vs 0.6 +/- 0.4 days; p < 0.05). CONCLUSIONS: These data suggest a causal role for LTB4 in the generation of pulmonary dysfunction in patients undergoing abdominal aortic aneurysm repair, similar to what has been shown in animal models.

Aged↗
PubMed1994

Pulmonary failure and the production of leukotrienes.

The activation of neutrophils and elaboration of leukotrienes has a role in the pathophysiologic factors of many of the disease states seen by surgeons and nonsurgical counterparts. Although direct evidence of cause and effect is lacking, there is a growing array of literature proving the importance of neutrophils and LTB4 in the pathophysiologic factors of ARDS and MOF after significant illness or injury. Experimental and clinical data using alteration of arachidonic acid metabolism through drugs or diet should begin to accumulate to regulate the detrimental inflammatory response seen after severe illness or injury.

Animals↗
PubMed1992

Postlaminectomy aortic pseudoaneurysm.

Vascular injuries after lumbar laminectomy for disc disease may result in acute life-threatening hemorrhage, chronic arteriovenous fistula, or pseudoaneurysm formation. This case report concerns a 53-year-old woman who developed an aortic pseudoaneurysm after an L2/L3 lumbar discectomy, diagnosed by abdominal computed tomography (CT) scan and aortogram. The patient fully recovered after celiotomy and repair of the aortic tear. The majority of vascular injuries associated with lumbar laminectomy are found at the L4/L5 and L5/S1 levels, and few occur at L2/L3. Early diagnosis with CT scan and aortography is essential, because prompt exploration will minimize morbidity and mortality.

Aorta↗
PubMed1991

Erosion through the posterior gastric wall by a pancreatic pseudocyst secondary to gastric duplication.

Gastric duplications are the rarest form of enteric duplication. They account for about 20% of all gastrointestinal duplications. Delayed and missed diagnosis leads to prolonged morbidity and mortality. We report a case of a child with a gastric duplication cyst in the body of the pancreas, associated with a pancreatic pseudocyst that ultimately eroded into the posterior wall of the stomach.

Humans↗
PubMed1989

Laryngotracheal injury following cricothyroidotomy.

Airway complications following elective cricothyroidotomy were reviewed in 48 adult cardiothoracic surgery patients. A 52% incidence of airway complications was found and manifested by failed or delayed decannulation, extensive subglottic granulation tissue, stenosis, vocal cord paralysis, and aspiration pneumonia. The most common cause for decannulation difficulty was subglottic stenosis (50%). Several risk factors were specifically identified, including a period of cricothyroid cannulation exceeding 30 days, the presence of diabetes, and advanced age. These findings suggest that airway sequelae following cricothyroidotomy in cardiothoracic surgery patients is higher than previously reported. Indications and risk factors for cricothyroidotomy are discussed.

Aged↗
PubMed1989

Cocaine-induced acute aortic dissection.

While cocaine-induced myocardial infarction has been frequently documented, the differential diagnosis of chest pain should include aortic pathology. The successful management of acute aortic dissection secondary to cocaine abuse has not been previously reported to our knowledge. In a 45-year-old man who presented with typical chest pain and wide mediastinum, the successful management of this disease included early and accurate diagnosis and replacement of the aortic valve as well as the torn portion of the ascending aorta.

Aortic Dissection↗
PubMed1987

Prediction of relapse in schizophrenia.

Despite the proven efficacy of neuroleptic drugs in the acute and maintenance pharmacotherapy of schizophrenia, practical methods for identifying patients who require neuroleptic treatment to prevent relapse are lacking. This study evaluated the use of a methylphenidate challenge test to predict the outcome in 34 stable outpatients with schizophrenia receiving neuroleptic treatment. Patients received two infusions, one of methylphenidate and one of placebo, in randomized order one week apart while receiving neuroleptic treatment and again three weeks after drug withdrawal. Behavioral, cardiovascular, and neurologic responses were evaluated before and after infusion under double-blind conditions. Patients were then followed up without medication for 52 weeks or until symptom recurrence. The results indicate that specific measures, including behavioral response to methylphenidate, presence of tardive dyskinesia, and, under specific pharmacologic conditions, tardive dyskinesia, blink-rate, and pulse-rate responses to methylphenidate, are associated with time and propensity to relapse following neuroleptic withdrawal. These measures may be potentially useful in the identification of candidates for neuroleptic withdrawal and/or dosage-reduction treatment strategies.

Adolescent↗
PubMed1984

Methylphenidate challenge as a predictor of relapse in schizophrenia.

Although neuroleptics are the major treatment for schizophrenia, there are no effective measures to determine the appropriate or necessary length of neuroleptic maintenance. To test the ability of a psychostimulant challenge to predict relapse following neuroleptic withdrawal, the authors administered methylphenidate and placebo infusions to 11 stable schizophrenic outpatients who had been on a neuroleptic maintenance regimen for at least 6 months. Patients withdrawn from neuroleptics were followed until relapse. All three patients with a positive response to methylphenidate challenge relapsed in 1 to 7 weeks; one of seven negative responders relapsed at week 21. Differences in relapse rates (p = .033) and survival time (p = .005) between negative and positive responders were significant.

Adult↗
PubMedDate not supplied

Isolated intrathoracic injury with air bag use.

The restrained (air bag and seatbelt) driver of a vehicle involved in a high-speed motor-vehicle accident sustained a tear of the thoracic aorta with no signs of external injury. Air bag deployment may mask significant internal injury, and a high index of suspicion is warranted in such situations.

Accidents, Traffic↗
PubMedDate not supplied

An evaluation of three blood pressure methods in a stabilized acute trauma population.

Blood pressure values were evaluated in 30 acute adult trauma patients using two indirect methods, the bell and diaphragm components of the stethoscope, and one direct arterial method. K1, K4, and K5 measurements were taken 4 to 72 hours (M = 30) after admission when vital signs had stabilized. Data were collected using a random-zero (RZ) sphygmomanometer for indirect blood pressure and radial intraarterial cannula for direct blood pressure. The sequence of measurement was randomized and variables shown to alter blood pressure values were controlled. There was no overall significant difference in K1, K4, and K5 blood pressures among the three methods. These results suggest that when clinicians monitor variables such as the frequency response of arterial lines and peripheral vascular resistance, indirect blood pressure methods are reliable for use with stabilized trauma patients.

Adolescent↗