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Biomedical subjects

G F Reinhardt

Publications and source records attributed to G F Reinhardt.

17 recordsLinked to original sources
PubMed1996

Peritoneal fibrosis in cirrhotics treated with peritoneovenous shunting for ascites. An autopsy study with clinical correlations.

Of 554 cirrhotics autopsied during 1975-1993, 69 had had peritoneovenous shunts. Generalized peritoneal fibrosis with cocoon formation was found in 26 (38%) of those with shunts but in only one of 485 without shunts (P = 0.00002). In 14/26 the fibrosis was asymptomatic, an incidental autopsy finding. Intestinal obstruction in 12/26 (46%), the only symptomatic manifestation, was fatal in five. The etiology of peritoneal fibrosis in shunted patients is unknown. The 26 patients with fibrosis had more prior abdominal operations, complicated abdominal wall hernias, and active biliary tract inflammations; the features differentiated them from the 43 patients without fibrosis. Scores in a 'peritoneal complication index,' that considered multiple risks in the same patients, were significantly higher in those with fibrosis. In addition to these peritoneal injuries or inflammations, the faster ascitic fluid circulation in shunted patients may have increased deposition of fibrin upon the peritoneum. Fibrogenic cytokines, thus spread throughout the abdomen from local sites, may have converted fibrinous adhesions to generalized peritoneal fibrosis.

Ascites↗
PubMed1988

A randomized clinical trial of total parenteral nutrition in malnourished surgical patients: the rationale and impact of previous clinical trials and pilot study on protocol design.

The rationale for a large-scale clinical trial of preoperative total parenteral nutrition (TPN) is described in the context of previous clinical trials that have attempted to demonstrate reduction of operative morbidity with preoperative TPN. Defects in study design or execution potentially compromising the validity of these studies are analyzed. Results of a single-institution pilot study performed during the planning phase of the multiinstitutional preoperative TPN trial are presented. This literature review and pilot study provided the data necessary to permit appropriate design of many critical elements in the protocol for the clinical trial including sample size, eligibility criteria, duration and intensity of treatment regimens, and end-point criteria. The rationale underlying critical decisions in protocol design are presented in detail to allow more meaningful interpretation of the results of the clinical trial.

Clinical Trials as Topic↗
PubMed1988

Study protocol: a randomized clinical trial of total parenteral nutrition in malnourished surgical patients.

CSP #221 is a randomized multiinstitutional clinical trial to assess the efficacy of 10 d of perioperative total parenteral nutrition (TPN) in reducing morbidity and mortality in malnourished patients undergoing intraperitoneal and/or intrathoracic operations. In this paper a detailed protocol for the clinical efficacy trial is presented primarily as a reference document for use in interpretation of the results of the clinical trial. It is also anticipated, however, that review of this protocol may be useful to other investigators planning future clinical nutrition intervention trials.

Clinical Trials as Topic↗
PubMed1981

Intractable ascites treated with peritoneovenous shunts (LeVeen). A 24- to 64-month follow-up of results in 52 alcoholic cirrhotics.

Peritoneovenous shunts (LeVeen) were placed in 52 patients with intractable ascites due to alcoholic cirrhosis between March 1975 and June 1978. The ascites was defined as intractable if it persisted despite at least six weeks of in-hospital medical management. Only 4.5% of such patients seen during this interval met this criterion by failing to respond to intensive drug and diet therapy. Eight (15%) died five to 60 days postoperatively; six of these did not undergo diuresis. Hepatic encephalopathy and sepsis were important contributing factors. There were 21 late deaths (mean survival, 16 months), primarily related to complications characteristic of this group of cirrhotics: upper gastrointestinal hemorrhage and infection. Twenty-three patients were alive by June 25, 1980, with mean survival of 46 months. Four patients operated on five or more years ago survive without ascites. An accurately placed LeVeen shunt dramatically relieves intractable ascites with improvement in renal function, nutrition, and general health. The operation enables at least partial rehabilitation so that ambulatory care becomes feasible for many of these chronically and seriously disabled patients.

Adult↗
PubMed1979

Primary tumors of the small intestine.

Seventy-two malignant and 19 benign tumors were seen at the Veterans Administration Hospital, Hines, Illinois, from 1950 to 1976. Of these, 44 malignant and 14 benign tumors were seen in the clinical setting--the remainder were found at autopsy. Carcinoid tumors were the most common malignant tumors, followed by adenocarcinoma, lymphoma and leiomyosarcoma. Patients with malignant tumors usually presented with abdominal pain, vomiting and weight loss. The most common clinical signs were anemia, abdominal tenderness and abdominal distention. The most useful diagnostic tests were upper GI series and plain x-ray of the abdomen. Twenty-one (50%) five year survivals and 14 (33%) ten year survivals were obtained with small bowel malignancies. The majority of the five and ten year survivals were patients who had carcinoid tumors and lymphoma. Various theories on the causation of small bowel malignancies are discussed.

Adenocarcinoma↗
PubMed1978

Catheter infection factors affecting total parenteral nutrition.

During the five-year interval from January 1, 1971 to January 1, 1976 118 seriously ill adults received 2916 patient days of TPN therapy with an average infection rate of 7.6%. All patients received the benefit of a well-defined TPN catheter care protocol which emphasized regular (every 48 hours) catheter dressing changes. The lowest risk of infection, 2.7%, was seen in 73 patients who received an amino acid-glucose solution through a silicone elastomer catheter protected by an iodophor dressing. When catheter-related sepsis occurred, Staphlylococcus aureus and Candida albicans were the most common organisms cultured.

Adult↗
PubMed1977

Total parenteral nutrition.

Total parenteral nutrition has evolved as a distinct therapeutic reality within the past decade. Starvation or malnutrition need no longer be accepted as a necessary component of prolonged illness. Though current TPN techniques can be both safe and effective, the prevention of potential complications must always have a high priority. Changes in technique are to be anticipated as further knowledge and improved materials allow the pursuit of more basic clinical problems. The recent experience with the use of high caloric TPN solutions for prolonged gastrointestinal failure in 73 patients at the Loyola University Medical Center has been summarized. The need for the involvement of an experienced TPN team in the care of these patients cannot be overemphasized if the numerous and diverse potential complications of the TPN system are to be minimized.

Catheterization↗
PubMed1977

Peritoneovenous shunting for ascites.

The peritoneovenous shunt of LeVeen can be safely performed under local anesthesia in patients with advanced cirrhosis and ascites. The results of the technique described have proved satisfactory in 25 diuretic resistant ascites in selected patients. The rapid, downhill course of the patient with severe hepatic encephalopathy or coma is probably unchanged by the presence of the valve. Eighteen surviving patients discharged with shunts in place are under continuing study.

Adult↗
PubMed1976

Pseudomonas cepacia strains isolated from water reservoirs of unheated nebulizers.

Pseudomonas cepacia strains were isolated from the water reservoirs of unheated nebulizers in a hospital setting. The isolates were characterized by morphology, biochemical tests, and antibiotic susceptibility patterns. An interesting feature of these organisms was their capacity for sustained multiplication in either doubly deionized or doubly distilled water as well as 5% dextrose or 0.9% saline. They could not multiply in doubly deionized and then doubly distilled water or in any of several parenteral nutrition solutions studied. Isolation of Pseudomonas cepacia from the water reservoirs of unheated nebulizers suggests that this equipment may serve as a source of respiratory tract exposure to the organism.

Equipment and Supplies, Hospital↗
PubMed1973

Multiplication of nosocomial pathogens in intravenous feeding solutions.

A major problem in total parenteral nutrition is sepsis, particularly that caused by Candida. Studies of four solutions, a casein hydrolysate, a fibrin hydrolysate, and two crystalline amino acid solutions, show that the protein hydrolysate solutions appear to be highly selective for Candida over bacteria, whereas the crystalline amino acid solutions are not. These findings suggest that the crystalline amino acid preparations may offer a partial solution to the infection problem by minimizing the contribution of the solution as a reservoir for organism multiplication, because they retard the growth of both bacteria and Candida.

Amino Acids↗
PubMedDate not supplied

Incidence and mortality of hypoalbuminemic patients in hospitalized veterans.

The purpose of this study was to determine the incidence of hypoalbuminemia (HAlb) in a hospitalized male veteran population. Computerized surveillance of all clinical serum albumin determinations was performed during a 60-day interval. Each patient with an albumin level of 3.4 g/100 ml or less was identified and classified as an A, B, C, or D patient, based on the lowest recorded albumin level. After classification, each patient was followed either until death or for a minimum of 60 days. From a population of 2060 hospitalized veterans, 509 were identified as having HAlb for an incidence of 24.7%. The 30-day mortality rate for these 509 patients was 24.6%. The highest mortality rate, 62.0%, was seen in 50 group D patients whose albumin levels fell to 2.0 or below. For all HAlb patient groups, a linear correlation could be demonstrated between the level of HAlb observed and the subsequent 30-day mortality rate. It is concluded that, in our hospitalized veteran population, HAlb is a common finding and is associated with an increased 30-day mortality rate.

Adult↗