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Biomedical subjects

D J Ludwig

Publications and source records attributed to D J Ludwig.

14 recordsLinked to original sources
PubMed2001

A prospective evaluation of dietary status and symptoms after near-total esophagectomy without gastric emptying procedure.

BACKGROUND: After esophagectomy, the stomach is the most commonly utilized reconstructive conduit. There remains debate among surgeons regarding the requirements for pyloroplasty/pyloromyotomy following reconstruction. We present a series of patients having undergone near total esophagectomy and reconstruction with gastric tube without gastric emptying procedure to analyze critically these patients' ability to reestablish a subjectively acceptable and nutritionally adequate eating pattern without significant side effects of early satiety, dumping, or diarrhea. METHODS: Between 1991 and 1998, 48 patients underwent esophagectomy utilizing this technique and were available for long-term follow-up and nutritional assessment. Patient weights were recorded at 2 weeks, 6 months, and 1 year and a telephone interview conducted at a mean of 36 months postoperatively for the evaluation of eating patterns and symptoms. A subgroup of these patients (32 of 48) completed a 3-day dietary record that was assessed by a certified nutritionist. This patient group included 10 patients (21%) who had received perioperative chemoradiotherapy. RESULTS: Dietary intake was characterized as normal or minimally limited in 41 patients (85%). Those who had received perioperative chemoradiotherapy needed no significant increased time to return to a normal dietary baseline (6.1 versus 5.9 months). Mean weight loss prior to surgery was 3 kg. Weight loss continued for the first 6 months (mean 10 kg); however, 63% were able to gain weight from 6 months to 1 year following surgery (mean 3 kg). Most patients were overweight prior to operation (mean 115% of ideal body weight) and achieved a new postoperative baseline (mean 104% of ideal body weight) at 1 year. Patients demonstrated a mean daily caloric intake of 2,179 kilocalories per day, which was 98% of recommended according to their ideal body weight. Postoperative symptoms of short-term nausea (19%), occasional dysphagia with certain foods (38%), mild increased stool frequency (15%), and occasional regurgitation (25%) were noted. CONCLUSIONS: Near-total esophagectomy with verticalized gastric tube without a gastric emptying procedure is well tolerated and allows a return to subjectively acceptable and nutritionally appropriate dietary eating pattern without significant associated side effects.

Adult↗
PubMed1999

Mesenteric and portal vein thrombosis in a young patient with protein S deficiency treated with urokinase via the superior mesenteric artery.

A 32-year-old man, who was previously healthy, had acute abdominal pain without peritonitis. Diffuse mesenteric and portal vein thrombosis were shown by means of a computed tomography scan. A protein s deficiency was found by means of an extensive workup for hypercoagulable state. Successful treatment was achieved with urokinase infusion via the superior mesenteric artery without an operation. This represents an attractive alternative approach to treating patients with this disease. The previous standard of operative intervention(1) can now be reserved for complications, such as bowel infarction with peritonitis, or for those patients with absolute contraindications to thrombolytic therapy.

Abdominal Pain↗
PubMed1997

Gut stromal tumors and their clinical behavior.

BACKGROUND: Gut stromal tumors (GST) are a group of intramural intestinal tumors formerly known as leiomyoma and leiomyosarcoma. To improve the understanding of GST behavior, we posed the following questions: What are the clinical sequelae? Do size and symptoms correlate? What are the indications for excision? METHODS: A retrospective analysis (1988 to 1996) of the clinical course for GST patients was completed including long-term follow-up. RESULTS: We found 39 patients with GST during the last 8 years. Their average age was 65 years and 59% were male. Tumors were found in the small bowel or stomach in 95% of cases. All patients were treated by surgical excision. Histologic grading yielded a benign diagnosis in 77%. Tumors were found incidentally at laparotomy in 41% and had an average size of 1.5 cm. In contrast, 59% of GST patients were symptomatic and the average size was 6 cm. In these 23 symptomatic patients, gastrointestinal bleeding occurred in 70%, of which acute hemorrhage was seen in 69-82% of them required transfusion and half required emergent operation. Additional findings in the symptomatic group included abdominal pain (57%), bowel obstruction (30%), and perforation (9%). An average long-term follow-up of 2.5 years was obtained in all patients (n = 34, 5 had died of other causes). Local recurrence was seen in 2 patients, metastatic disease in 2 other patients, and 30 (88%) were disease free. No patient with a GST discovered incidentally has had it recur. CONCLUSION: Gut stromal tumors are uncommon yet cause significant patient morbidity. Small GST (<2 cm) were asymptomatic but larger GST were usually symptomatic. Most GST behaved in a benign fashion after local resection. Due to the frequency of serious complications in symptomatic patients, complete excision is recommended for GST, even if incidentally discovered.

Adult↗
PubMed1983

The pharmacist as a member of the CPR team: evaluation by other health professionals.

Physician and nurse evaluation of the pharmacist's participation on the cardiopulmonary resuscitation (CPR) team was studied, in an attempt to justify the pharmacist's role. A pharmacist-evaluation questionnaire was prepared, based on the Likert Method. This questionnaire contained ten statements related to organizational and mechanical contributions, drug information contributions, and overall contribution and desire, by other health professionals, for continuance of this service. Pharmacists attended all CPRs during a six-month period and distributed a questionnaire to one physician and one nurse in attendance. Verification was obtained that these individuals had attended previous arrests where pharmacists were not in attendance. Only those evaluations that were completed and returned by the physician or the nurse, to the Department of Pharmaceutical Services, were evaluated. Results indicated that physicians and nurses are in agreement with the pharmacist's organizational and mechanical contribution. Both physicians and nurses tended toward agreement with the pharmacist's drug information contribution. Finally, physicians and nurses are in agreement with the pharmacist's overall contribution to the CPR team and desire continuance of this service.

Humans↗
PubMed1983

Controlling moxalactam and cefotaxime use with a target drug program.

A target drug program was utilized to prevent increasing costs associated with inappropriate use of moxalactam and cefotaxime. The cost saving abilities of pharmacists in this regard were calculated. Pharmacists consulted with physicians each time these drugs were prescribed to encourage cefazolin substitution when appropriate. Records of all cephalosporin piggyback doses dispensed were maintained along with quarterly purchase data. Excess costs of utilizing third generation cephalosporins in place of cefazolin were calculated for various usage levels. Actual third-generation usage was compared to usage predicted if no target program was in place, and cost saving was calculated. During the study period, combined moxalactam and cefotaxime use averaged 3.2% of total cephalosporin use at a cost of $4109 per month. Based on an expected predicted usage of 20% to 40%, an annualized cost savings of $91,071 to $202,815 was achieved. Clinical pharmacists were very effective in preventing inappropriate use of moxalactam and cefotaxime, preventing a rise in drug costs.

Anti-Bacterial Agents↗
PubMed1978

Apparent stability of nitroglycerin in dextrose 5% in water.

The apparent stability profile of nitroglycerin (NTG) in dextrose 5% in water when packaged in glass bottles and plastic bags was studied under the following conditions: room temperature (25 +/- 1 C) and room light, room temperature protected from room light, and refrigeration (4 C). NTG stability was assessed by monitoring drug disappearance from solution over a period of five hours after preparation of the admixtures. A spectrophotometric assay was used. There appeared to be no difference in the apparent rate of NTG disappearance when prepared in either glass bottles or plastic bags. Protection of the drug solutions from room light had no apparent effect on the disappearance pattern of NTG. Furthermore, although refrigeration of the NTG solutions appeared to increase the stability of the admixtures, this effect was not seen until approximately four to five hours after preparation of the solutions. It is possible that sorption onto the walls of the glass bottles and plastic bags may account for the observed disappearance of admixed NTG in dextrose 5% in water.

Colorimetry↗
PubMed1975

Retest reliability of the Rosenzweig Picture-Frustration Study and similar semiprojective techniques.

Surveys the evidence for the reliability of the Adult, Adolescent and Children's Forms of the Rosenzweig Picture-Frustration (P-F) Study. Analysis of variance and split-half methods, which assume item homogeneity and internal consistency, may be appropriate to psychometric tests, but they are not apposite to projective and semi-projective techniques. The implications of applying such criteria are critically examined, with the P-F Study as an example to demonstrate their nonapplicability. Investigations on retest (total test) reliability from the laboratory of the senior author and from those of other investigators demonstrate statistically significant consistency for the main scoring categories of the P-F, especially those relating to directions of aggression. Implications for other semiprojective techniques are expounded.

Journal Article↗
PubMedDate not supplied

Fungal pseudotumor masquerading as pancreatic cancer-a sequela of new technology?

Fungal infection resulting in chronic pancreatitis is rare. We report a case of chronic pancreatitis due to fungal infection causing common bile duct obstruction and abdominal pain mimicking pancreatic cancer. Treatment included resection to cure the pain and rule out malignancy. Long-term effects of fungal infection may be seen more frequently as total parenteral nutrition, antibiotics, and foreign bodies (e.g., stents, drains, central venous catheters) are more often being used in the treatment of many diseases.

Abdominal Pain↗