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Daniel A Saltzman

Publications and source records attributed to Daniel A Saltzman.

14 recordsLinked to original sources
PubMed2005

Long-term follow-up and the role of surgery in adolescents with morbid obesity.

PURPOSE: Obesity has become a health-care crisis in the United States. Adolescent obesity is now one of the most common childhood disorders, with 4.7 million American adolescents having a body mass index (BMI) greater than the 95th percentile. Most patients do not respond to diet modification or exercise programs and attention is now turning toward surgery as a source of weight loss in adolescents. Few studies have looked at the overall morbidity and mortality of weight loss surgery in this patient population. METHODS: This is a retrospective study of medical charts of 15 bariatric surgical procedures performed on 14 adolescents without known genetic syndromes associated with severe childhood obesity from 1971 to 2001 at the University of Minnesota. Procedures performed on these patients included vertical banded gastroplasty (n = 7), Roux-en-Y gastric bypass (n = 5), and jejunoileal bypass (n = 3). Jejunoileal bypass procedures were performed from 1971 to 1977, after which time this procedure was abandoned. Patient age ranged from 13 to 17 years (mean, 15.7 years). Mean follow-up time was 6 years, with 9 patients available for long-term follow-up. RESULTS: All procedures were performed using an open technique by 1 surgeon. There were no perioperative deaths; complications included 1 case of wound infection, 2 episodes of dumping syndrome that resolved without revision, 1 episode of hypoglycemia, and 1 case of short-term electrolyte imbalance in a patient who underwent jejunoileal bypass. The average BMI dropped from 58.5 +/- 13.7 to 32.1 +/- 9.7 kg/m(2) (P < .01)--a 45% reduction. CONCLUSIONS: Surgery for morbid obesity is safe and results in significant weight loss in adolescents who fail medical therapy.

Adolescent↗
PubMed2005

Attenuated Salmonella typhimurium invades and decreases tumor burden in neuroblastoma.

INTRODUCTION: We have previously shown that Salmonella elicits an antitumor response against hepatic adenocarcinomatous metastases. In vitro studies have demonstrated both intracellular invasion and proliferation of Salmonella within cultured neuroblastoma cells. We sought to demonstrate in vivo invasion, proliferation, and a potential antitumor response. METHODS: A murine model for retroperitoneal neuroblastoma was established with viable neuroblastoma cells. A green fluorescent protein (GFP--Clontech, Palo Alto, CA) gene was inserted into our attenuated Salmonella species via electroporation. Fourteen days after retroperitoneal injection, the Salmonella typhimurium-pGFP construct was administered and studied. In separate experiments, the antitumor effect against neuroblastoma was studied in controls, Salmonella lacking an interleukin 2 (IL-2) gene (Sal-NG), and Salmonella containing an IL-2 gene (Salmonella-pIL2 ). RESULTS: Consistent with previous reports, 74% of mice injected were found to have recognizable tumors. Salmonella was present within tumor cells. Average tumor volumes for control, Sal-NG, and Salmonella-pIL2 mice were 2024.3, 749.5, and 332.4 mm3 , respectively (P < .0001). Tumor weights for control, Sal-NG, and Salmonella-pIL2 mice were 2.218, 0.880, and 0.377 g, respectively (P < .0001). CONCLUSIONS: Attenuated Salmonella species can now be tracked via fluorescent microscopy within tumor cells. Furthermore, an 84% reduction in tumor burden was observed in those animals gavage fed Salmonella with the IL-2 gene.

Animals↗
PubMed2005

American Academy of Pediatrics Section on Surgery hernia survey revisited.

BACKGROUND: The aim of the study was to describe current treatment and trends in surgical management of pediatric inguinal hernias (IHs), specifically contralateral exploration. METHODS: Surveys were sent to 599 Surgical Section members. Questions paralleled the 1993 American Academy of Pediatrics survey and addressed recent controversial topics. Statistical analysis by chi2 was performed. RESULTS: Three hundred ninety-five (66%) surveys returned. For full-term boys with reducible IH, 79% (82%) repair electively, regardless of age or weight. For full-term girls with reducible ovary, 49% (27%) repair electively, 36% (59%) next available slot, 5% (10%) emergently (P < .01). In former premature infants, 53% (65%) repair reducible IH when convenient, regardless of age. For unilaterally presenting IH, 44% (65%) routinely explore contralateral groins in boys 2 years or younger (P < .01); 47% (84%) routinely explore girls 4 years or younger (P < .01). No significant association between routine exploration patterns and years in practice, region of country, or training program affiliation was found. Laparoscopic evaluation for contralateral IH was reported by 37% (6%), (P < .01) 1993 results italicized. CONCLUSION: Reports of routine contralateral inguinal exploration had absolute decreases of 21% for boys 2 years or younger, 37% for girls 4 years or younger. There has been a shift toward elective repair for girls with reducible ovaries. Use of laparoscopy for diagnostic contralateral evaluation has increased dramatically.

Anemia↗
PubMed2005

Cancer immunotherapy based on the killing of Salmonella typhimurium-infected tumour cells.

The use of bacteria for anticancer purposes was first attempted over 100 years ago. Recently, several strains of Salmonella have been shown to possess anticancer activity and, interestingly, Salmonella possesses a unique propensity to track to tumour tissue in vivo. This review presents the use of Salmonella for cancer immunotherapy, including the distinguishing characteristics of this organism and preclinical as well as clinical data.

Animals↗
PubMed2004

Preferential proliferation of attenuated Salmonella typhimurium within neuroblastoma.

BACKGROUND/PURPOSE: Attenuated Salmonella typhimurium, a facultative intracellular parasite that colonizes the liver, has been shown to accumulate within extrahepatic malignancies. The authors sought to define a mechanism for attenuated Salmonella accumulation within cancer cells compared with hepatocytes. METHODS: Invasion and intracellular proliferation of attenuated Salmonella was assessed through an in vitro assay performed on neuroblasoma, osteosarcoma, hepatoma, and colon adenocarcinoma cell lines and compared with freshly isolated mouse hepatocytes. RESULTS: The efficiency of attenuated S typhimurium invasion into hepatocytes was greater than any malignant cell line (3.8 v 0.46; P <.04). However, the intracellular proliferation of the bacteria was most abundant within neuroblastoma, exceeding the proliferation within hepatocytes (14.3 v 6.2; P <.01). CONCLUSIONS: Attenuated S typhimurium may prove to be an effective in vivo immunotherapy for the local delivery of therapeutic proteins to neuroblastoma.

Adenocarcinoma↗
PubMed2004

Spontaneous liver rupture in a child with graft-versus-host disease.

Graft-versus-host disease (GVHD) is a common complication in the stem cell transplant (SCT) patient. The skin, gastrointestinal tract, and the liver are the most frequently affected organs. The authors present the first reported case of a spontaneous rupture of the liver in a child with GVHD after SCT.

Adolescent↗
PubMed2003

Attenuated Salmonella typhimurium prevents the establishment of unresectable hepatic metastases and improves survival in a murine model.

PURPOSE: The authors investigated the utility of attenuated Salmonella typhimurium for preventing the establishment of hepatic metastases in a murine model. METHODS: A single, oral 10(8) cfu dose of attenuated S typhimurium was given 8 days before the establishment of a model of unresectable hepatic metastases. Animals were assessed for hepatic tumor number and volume, hepatic lymphocyte population analysis, and survival. RESULTS: Pretreatment with Salmonella provided a 10-fold reduction in hepatic tumor burden compared with saline-treated controls. The antitumor effect is associated with markedly elevated natural killer (NK), CD8+ and CD4+ hepatic lymphocytes. Pretreatment with Salmonella provided a 90-day survival rate of 30%, whereas control animals were dead by 30 days. All long-term survivors were devoid of hepatic tumor. CONCLUSIONS: Attenuated S typhimurium effectively prevents the establishment of hepatic metastases in a murine model, providing a clear survival benefit. Thus, it may represent a novel form of in vivo immunotherapy for the prevention of hepatic metastases for patients with locally advanced colorectal cancer.

Adenocarcinoma↗
PubMed2003

Rectal impalement: a case review.

Pediatric impalement injuries to the rectum are rare, and delays in diagnosis can be life threatening. We report the case of a young girl who was accidentally impaled on a dive stick. A review of historical aspects of rectal trauma and current management techniques are discussed. Rectal injuries in the pediatric population most often result from accidental impalement, sexual abuse, or blunt trauma. In contrast, most rectal injuries in adults are caused by missile wounds. Moreover, because rectal injury is fairly uncommon in children, physicians evaluating patients may miss signs of serious injury. Signs of external trauma may be minimal when rectal perforation exists, so delays in diagnosis are not uncommon.

Child, Preschool↗
PubMed2002

Surgical experience in patients with cystic fibrosis: a 25-year perspective.

The spectrum of surgical diseases in patients with cystic fibrosis (CF) has not been comprehensively studied. A retrospective review of 792 consecutive patients with CF presenting over a 25 year period (1970-1994) was made to determine the incidence of operations, procedures performed, complications encountered, and impact on physical development and pulmonary function tests (PFTs). A total of 191 operations were performed on 130 (16%) of the 792 patients; 98 operations (51%) were abdominal, 58 (30%) thoracic, and 31 (16%) hernias; 64 were male, and 66 female; average age was 14 +/- 10 years. Complications occurred in 12 (16%); 9 deaths were from progressive respiratory failure, 2 from superficial wound infections, and 1 from an episode of line sepsis. In the first 15 years, 9 complications occurred in 126 operations vs. 3 in 73 operations during the last 10 years. Operations were classified as emergent, urgent, or elective. Of the 9 deaths, 8 occurred after emergent or urgent operations (4 abdominal and 4 thoracic), while 1 death occurred following elective herniorrhaphy. For each subgroup, (abdominal, thoracic, and hernia), there was no difference in height/weight indicies, peak flow, forced vital capacity (FVC), forced expired volume in 1 sec (FEV(1)), or FEV(1)/FVC ratio when comparing 1 year preoperation and 1 year postoperation. In conclusion, patients in this high-risk population were operated on with few complications, but when a complication occurred it tended to be pulmonary and fatal (4.7% of all operations). Furthermore, operations did not cause significant deteriorations in PFTs and they did not cause these children to fall off their expected age-adjusted growth curves.

Abdomen↗
PubMed2002

Prospective study of the incidence and complications of bacterial contamination of enteral feeding in neonates.

PURPOSE: The goal of this study was to determine incidence of, and complications resulting from, bacterial contamination of enteral feedings in neonates. METHODS: A prospective study of 50 tube-fed neonates was conducted. Infants were bolus fed via an open gravity drained system; demographic and clinical data were gathered. The lumen of the tube was cultured quantitatively after 7 days. All organisms were isolated, identified, frozen, and stored to correlate with clinical cultures. RESULTS: The 50 neonates were fed for a mean of 17.6 days each and represent 125 patient weeks (1 tube per patient per week). A total of 71 of 125 tubes were "contaminated" (>1,000 colony forming units [CFU]/mL), with a mean 908,173 CFU and 3 different bacteria types. Among formula-fed infants, feeding intolerance occurred in 24 of 32 weeks with contaminated tubes versus 0 of 44 weeks with noncontaminated tubes (P <.05). Contamination occurred in 41 of 48 weeks in patients on H2 antagonists versus 32 of 66 weeks in patients with normal gastric acidity (P <.05). Necrotizing enterocolitis developed in 7 patients; all were fed formula contaminated with greater than 100,000 CFU/mL of Gram-negative bacteria. Four required operation; intraoperative cultures found the same organism as cultured previously in the tube in all 4 infants. CONCLUSION: Bacterial contamination of enteral feeding occurs frequently, causes significant feeding intolerance, and may contribute to NEC.

Bacterial Infections↗
PubMed2002

Fibrin sheath enhances central venous catheter infection.

OBJECTIVE: To determine whether fibrin-coated central venous catheters have a higher infection rate, and spawn more septic emboli, than uncoated catheters after exposure to bacteremia. DESIGN: Animal study comparing catheter infection and blood cultures of fibrin-coated and uncoated catheters exposed to bacteremia. SETTING: Animal laboratory. SUBJECTS: Adult male Sprague-Dawley rats. INTERVENTIONS: A total of 210 rats had catheters placed with the proximal end buried subcutaneously. Rats were divided into three groups: tail vein bacterial injection on day 0 (no fibrin group) or on day 10 (fibrin group), or no injection/saline injection (control, n = 40). Bacterial injections were 1 x 108 colony forming units of either Staphylococcus epidermidis (n = 100) or Enterobacter cloacae (n = 60). Animals were killed 3 days after injection. Blood cultures were obtained via cardiac puncture, and catheters were removed via the chest. Half of the catheter was rolled onto agar and the other half was placed in trypticase soy broth. Plates and broth were incubated at 37 degrees C for 48 hrs. The presence of >15 colonies on roll plates, or growth in broth, was accepted as a positive sign of infection. Microscopy was performed on day 20-10 catheters. Thirty animals without catheters had bacterial injections and underwent blood culture 3 days after injection. MEASUREMENTS AND MAIN RESULTS: Catheter infection with S. epidermidis occurred in 32% of roll plates and 80% of broth from the fibrin group vs. 4% and 20% from the no fibrin group (p <.01 for each). Catheter infection with E. cloacae occurred in 50% of roll plates and 80% of broth from the fibrin group vs. 0% and 12% from the no fibrin group (p <.01 for each). Positive blood cultures occurred in 47 of 68 animals from the fibrin group vs. 8 of 68 from the no fibrin group (p <.01). Microscopy showed a fibrin sheath on 20 of 20 catheters. Without catheters, 30 of 30 blood cultures were negative. CONCLUSION: The fibrin sheath significantly enhanced catheter-related infection and persistent bacteremia.

Animals↗
PubMed2002

Acidification of formula with citric acid is equally effective and better tolerated than acidification with hydrochloric acid.

OBJECTIVE: To determine whether acidification of formula with citric acid is equally protective against bacterial translocation and gut colonization but better tolerated than acidification with hydrochloric acid in neonatal rabbits. DESIGN: Paired animal model with control. SETTING: Animal laboratory. SUBJECTS: Premature neonatal New Zealand rabbit pups. INTERVENTIONS: A standard neonatal rabbit model in two versions, a bacterial challenge and a no bacterial challenge model, was used to assess bacterial translocation and gut colonization. Two hundred forty-six rabbit pups were delivered by cesarean section 1 day premature and randomly placed into two groups sorted by type of formula acidification (hydrochloric acid or citric acid). Pups were gavage fed pH 3 kitten formula every 12 hrs. Ranitidine hydrochloride at 20 mg x kg(-1) x day(-1) was added to all formula. Bacterial challenge animals were given 1 x 10(6) colony-forming units/mL of Enterobacter cloacae with the third feeding. Animals in the no bacterial challenge group received no bacterial challenge. Animals were killed on day of life 3, and the liver, spleen, mesenteric lymph nodes, and cecum were sequentially harvested and cultured. Organs were qualitatively judged for growth, whereas cecal cultures were quantified as colony-forming units/gram. Stomach biopsies were performed to look for mucosal damage. Long-term tolerance was assessed in 48 pups fed formula acidified to pH 3 with either hydrochloric acid or citric acid and 20 animals fed pH 7 formula without ranitidine. Weight gain and mortality rate were followed for 14 days. MEASUREMENTS AND MAIN RESULTS: Gut colonization and bacterial translocation to liver, spleen, and mesenteric lymph nodes were equivalent between citric acid and hydrochloric acid in both bacterial challenge and no bacterial challenge models. Long term, citric acid animals exceeded hydrochloric acid animals in daily weight gain and survival (p <.05 for both) and equaled pH 7 animals in these measurements. CONCLUSION: Acidification of formula with citric acid is equally protective against bacteria but better tolerated than acidification with hydrochloric acid.

Animals↗